Painful penetration or dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during, or after intercourse. Many women experience discomfort during vaginal penetration now and then. But for some, painful sex becomes a regular part of their intimate lives.
Dyspareunia makes the prospect of sex distressing, disrupting a woman’s intimate life. Some women are able to put up with the discomfort or detach from their sexuality, but that is likely to cause further problems down the line. Unfortunately, dyspareunia can affect anyone, regardless of age or lifestyle. The good news is that in many cases, it can be easily treated.
According to a UK study, 1 in 13 women experiences painful intercourse that lasts for more than three months a year.
Symptoms of painful sex include:
Painful intercourse happens for a variety of reasons. Even women who have no prior health concerns can feel discomfort during penetration due to minor issues such as lack of lubrication. However, some of us suffer from physical and mental conditions that make vaginal sex dreadful.
Here is a list of the leading causes:
Vaginismus. A person living with vaginismus might feel pain from vaginal intercourse, a tampon, or even a doctor’s checkup because her vaginal walls contract uncontrollably during any kind of penetration. Patients describe these sensations as a burning ache or a feeling of resistance during penetration. There is no one reason for vaginismus but is likely to be linked with anxiety and past negative sexual experiences.
Infections. When vaginal flora is overgrown with bacteria, the vagina becomes sensitive, itchy, and irritated. Common vaginal infections such as yeast infection or bacterial vaginismus can cause vaginal dryness and skin tears, making sex or any penetration painful. STIs (sexually transmitted infections) can also make sex uncomfortable and difficult. STIs such as chlamydia and gonorrhoea provoke genital irritation and tissue tearing, while genital herpes can cause extremely painful sores.
Inflammation of the cervix—cervicitis. Some vaginal infections and STIs lead to cervicitis. Painful penetration, cramps after sex, and irritation while urinating are all symptoms of cervicitis. If you’ve noticed similar symptoms, it’s important to visit your doctor to discover the root cause. A sore cervix and bleeding during sex can be symptoms of cervical cancer; your gynaecologist can perform a pap smear to rule it out. You can read our article on STDs here.
Fibroids—abnormal growths that form on the uterus. Uterine fibroids often don’t present any symptoms and are only discovered during the course of a regular gynaecological check-up. While fibroids are usually harmless, sometimes they can cause painful menstruation, cramping, and soreness during sex. You can read our article on fibroids here.
Endometriosis is when the lining of the uterus, or endometrium, begins to grow outside the uterine cavity. Symptoms differ from person to person, depending on where the endometrial cells have formed. Painful sex is a possible symptom; some women report a deep stabbing pain in the lower abdomen ranging from mild to severe.
Ovarian cysts. While it’s not uncommon for small ‘functional’ cysts to form on the ovaries and rupture during menstruation, but sometimes they grow bigger, causing pain during intercourse. You may feel pain because the penis brushes against the ovaries during intercourse, causing a cyst to release fluid. If you also experience painful, heavy irregular periods, acne, and weight gain, this may be an indication of polycystic ovarian syndrome.
Pelvic inflammatory disease. Inflammation often occurs due to sexually transmitted bacteria. This causes painful urination, abnormal vaginal discharge, bleeding between periods, and soreness from intercourse. If you fail to treat pelvic inflammation in time, it may lead to infertility, chronic pain, or ectopic pregnancy.
Menopause. With age, the oestrogen levels in a woman’s body decrease, thinning the vaginal tissue and reducing her natural lubrication. Menopause-induced vaginal dryness makes sex less enjoyable and can cause soreness and vaginal tears.
Childbirth. As a woman’s body focuses on nurturing her baby, oestrogen levels drop, and she might experience painful postpartum sex. Sex can also be painful if a new mother tries to have sex too early after giving birth, while her pelvic floor is still weak or tight.
Vaginal dryness. Lack of natural lubrication is one of the most common reasons for dyspareunia. Vaginal lubrication is tied to oestrogen levels. Oestrogen decreases during menopause or when using medications such as hormonal birth control, heart and blood pressure medication, or antidepressants. Without additional lubrication, sex can be unpleasant and lead to tissue tears.
Vulvodynia. This is the name for pain in an around the vulva, often characterized as a sharp, acute pain or a burning sensation, and is often triggered by an object being inserted into the vagina. The cause for vulvodynia is unknown, but it has been linked to physical conditions such as infections or allergic reactions, and psychological conditions such as a hyper-aroused nervous system.
Now that we have considered possible causes, let’s talk about what can be done to improve your sex life.
Identifying the problem is the first step to diagnosis and treatment. Doctors have to rule out STIs and vaginal infections. If these tests come back negative, your gynaecologist can recommend an echoscopy and pelvic exam to see if you have cysts, fibroids, or endometriosis. If the root cause is psychological, your doctor might suggest sex therapy or mindfulness techniques.
As dyspareunia is often the result of vaginal dryness, medications that increase vaginal lubrication can alleviate discomfort. Vaginal moisturizers and lubricants ease friction, thus reducing irritation and allowing vaginal tissue to recover more quickly after penetration. Oestrogen therapy is often prescribed to help cope with the symptoms of menopause, including vaginal dryness. However, this is not recommended for those at high risk of breast cancer.
While medications can treat the physical symptoms, the experience of painful sex can cause anxiety that lingers even after the physical problem has been treated. Talk to your partner about your experience and let them know your feelings around sex and intimacy; this can help heal emotional trauma and deepen intimacy.
To improve your sex life, here are a few things you can try:
Read our article on non-penetrative sex here.
Even if pain upon penetration persists, there is no need to write off sex entirely. There are plenty of ways to enjoy intimacy alone or with a partner. Although opening up about your experiences requires vulnerability, which can be frightening, don't just suffer in silence. Talking about painful sex with your partner and your doctor can help you find the cause and get much-needed treatment.
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