What is Painful Intercourse?
Pain or discomfort during intercourse is quite common among females and some males. About 60% of women experience painful intercourse at least once during their lifetime. Painful intercourse can also affect males; however, it is not as common. Medically referred to as “dyspareunia,” it is defined as chronic pain in the genital area either during or shortly after intercourse.1 Dyspareunia can be caused by many physiological and psychological factors, and the symptoms and description of pain may vary from person to person. Some females experience pain only during penetration, while others may experience a burning sensation or aching with any touch or act of penetration. It is important to note that dyspareunia, if chronic and severe, should be assessed and diagnosed by a doctor in order to be properly treated. Some of the most common causes of dyspareunia include, but are not limited to, physiological conditions, vulvodynia (chronic pain in the vulvar area), vaginismus, and vaginal atrophy caused by menopause. 2
Painful intercourse can be caused by physiological factors such as inadequate lubrication, the presence of scar tissue in certain areas, or the tearing of the hymen. These are often the most common causes of painful intercourse and can be relieved by the use of an artificial lubricant, such as KY Jelly or Astroglide. Urogenital conditions like urinary tract infections (UTIs), yeast infections (candidiasis), or urethral conditions are also common sources of sexual pain and can also be easily treated with prescription medication. It is recommended to urinate shortly after sexual intercourse and drink plenty of water to clean out the urethra and avoid infections that cause painful intercourse and general genital pain.
Vulvodynia (chronic pain in the vulvar area) is characterized as an itching or burning sensation or general discomfort in the vulva. Pain associated with vulvodynia does not necessarily stem from sexual activity; it can also be experienced with any type of pressure applied on the vulva including sitting down or wearing tight clothing.3 However, pain is most commonly exacerbated during intercourse. Vulvodynia can be diagnosed by a simple gynecological exam, which entails a physician using a Q-tip to apply pressure on the vulva while the patient verbally rates the relevant level of discomfort she is experiencing. There is no single “cure” for vulvodynia. Treatments are available however, and their effectiveness differs from person to person. These treatments include pelvic floor physical therapy, trigger point therapy, and myofacial release. These treatments are usually provided by a professional therapist in a medical facility. Lifestyle accommodations such as wearing loose clothing, rinsing after urination, and using ice on the vulva when pain is more severe can also temporarily alleviate the symptoms of vulvodynia.4
Endometriosis is a disease in which the endometrial lining of the uterus grows on the outside of the uterus and covers nearby organ. The pain caused by endometriosis during sexual activity is more commonly referred to as a “deeper pain” as opposed to “pain upon entry.” Symptoms of endometriosis can usually be alleviated by using birth control pills. Birth control pills serve as hormone therapy. Hormones, including estrogen and progestin, cause the patches of endometrial lining to go through a cycle similar to the menstrual cycle. Birth control pills stop the production of these hormones causing ovulation to stop and subsequently impede new patches from forming. Birth control pills also alleviate pain from cramping general minor discomfort.5 If you are experiencing any of the symptoms of endometriosis, it would be best to schedule an appointment with a physician to prevent any irreparable or severe damage to the reproductive organs.
Vaginismus is a condition characterized by involuntary spasms of the pelvic floor (PC) muscles that surround the vaginal canal and is often the most extreme form of dyspareunia. Females who experience vaginismus report extreme coital pain, characterized by burning or itching, particularly upon penetration. In the most extreme cases, penetration is impossible due to the increased tightness of the vagina caused by the involuntary contractions. Vaginismus is curable through proper medical care and patient cooperation. Common forms of treatment include pelvic floor physical therapy, dilator therapy, Botox injections, cognitive psychotherapy, and sexual therapy.
Symptoms of menopause can also lead to pain during intercourse. During menopause, the female body produces smaller quantities of female sex hormones, primarily estrogen, which in turn alters the body’s natural sexual response. Decreases in estrogen levels lead to the thinning of the vaginal walls and their lining as well as a decrease in natural lubrication. The symptoms of menopause are medically referred to as “vaginal atrophy” and can cause painful sexual intercourse.4 Decreased lubrication causes an increased painful coital friction and because the vaginal walls are thinner and less elastic than before, they are more likely to become inflamed during coitus.5 Because of these physiological changes, sex is more likely to irritate nearby organs (bladder and urethra.) Hormonal changes can also cause the uterus to contract painfully during orgasms. Vaginal creams containing estrogen can be prescribed by doctors in order to combat vaginal atrophy. However, the use of any water-based lubricant (KY Jelly or Astroglide) has been proven to alleviate sexual pain associated with menopause .6
Dyspareunia can also be caused by certain psychological factors or certain sexual circumstances. It is common for females to experience anxiety and fear during sex, which can interfere with the body’s natural sexual response causing decreased lubrication and increased vaginal tightness. In order to combat negative internal monologue (the thoughts that exist internally that cause anxiety), it is important for females to relax and concentrate on the pleasure that sex can bring. Proper communication with your partner is also vital for increasing positive internal monologue, the thoughts that exist internally that help you relax and enjoy sex. Although psychological conditions do not all follow the biomedical model of diagnosis and treatment with medication, they are still a common source of dyspareunia and must also be assessed and treated to ensure a healthy and pain-free sex life. Experiences with sexual assault can cause anxiety and lead to sexual pain. Cognitive psychotherapy may be required to combat these symptoms.
Last Updated 1 May 2014.