The ManicaPost
Dr Tendai Zuze Health
PAINFUL sexual intercourse may be due to medical or psychological causes. The symptom is significantly more common in women than in men, affecting up to one-fifth of women at some point in their lives.
The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. In men, as in women, there are a number of physical factors that may cause sexual discomfort but we will focus on the fairer sex.
Physical causes of painful intercourse tend to differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.
Pain during penetration may be associated with a range of factors, including:
Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in oestrogen levels after menopause, after childbirth or during breast-feeding. In addition, certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision, episiotomy or a congenital abnormality.
Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.
Vaginismus; these are involuntary spasms of the muscles of the vaginal wall can make attempts at penetration very painful.
Deep penetration pain may be more pronounced with certain positions. Causes include:
Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, haemorrhoids and ovarian cysts.
Surgeries or medical treatments. Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.
Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:
Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
History of sexual abuse. Most women with painful sex don’t have a history of sexual abuse, but if you have been abused, it may play a role.
Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.
If an infection or medical condition is contributing to your pain, treating the underlying cause may resolve your problem.
Changing medications known to cause lubrication problems also may eliminate your symptoms. For most postmenopausal women, painful intercourse is caused by inadequate lubrication resulting from low oestrogen levels. Often, this can be treated with a prescription cream, tablet or flexible ring that releases very small amounts of oestrogen directly into your vagina.
Different types of therapy also may be helpful, including:
Desensitisation therapy. During this therapy, you learn vaginal relaxation exercises that can decrease pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse.
Counselling or sex therapy. If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counsellor or sex therapist can help resolve these issues.
You and your partner may be able to minimise pain with a few changes to your sexual routine:
Switch positions. If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help
Communicate. Talk about what feels good and what doesn’t. If you need your partner to go slow, say so.
Don’t rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
Use lubricants. A personal lubricant can make sex more comfortable. Read labels carefully or ask your doctor to recommend a product to try; for some women, personal lubricants that contain glycerine can promote yeast infections.
If you have any issues with painful intercourse, please visit your doctor.
