Pain During Intercourse

Pain intercourse
This is very common- nearly 3 out of 4 women have pain during intercourse at some time during their lives. Painful intercourse can occur for a variety of reasons — ranging from structural problems to psychological concerns. For some it is temporary problem, for others it is more permanent.
If you experience painful intercourse, you may feel:

• Pain only at sexual penetration (entry)
• Pain with every penetration, even while putting in a tampon
• New pain after previously pain-free intercourse
• Deep pain during thrusting
• Burning pain or aching pain

Where is pain during sex felt?

You may feel pain in your vulva, in the area surrounding the opening of your vagina (called the vestibule), or within your vagina. The perineum is a common site of pain during sex. You also may feel pain in your lower back, pelvic region, uterus, or bladder.

Causes
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.

Entry pain
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 estrogen 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. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

Deep pain
Deep pain usually occurs with deep penetration and 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, hemorrhoids 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.

Emotional factors
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 dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.
Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. 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.

Tests & Diagnosis

A medical evaluation for dyspareunia usually consists of:

• A thorough medical history. Your doctor may ask when your pain began, exactly where it hurts, how it feels, and if it happens with every sexual partner and every sexual position. Your doctor may also inquire about your sexual history, surgical history and previous childbirth experiences. Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your pain.

• A pelvic examination. During a pelvic exam, your doctor can check for signs of skin irritation, infection or anatomical problems. He or she may also try to identify the location of your pain by applying gentle pressure to the genital area and pelvic muscles. A visual examination of the vaginal passage, using an instrument called a speculum to separate the vaginal walls, may be performed as well. Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it's too painful.

• Additional tests. If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.

Treatment & Drugs

Treatment options will vary, depending on the underlying cause of the pain.

Medications
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, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with a prescription cream, tablet or flexible ring that releases very small amounts of estrogen directly to your vagina.

Therapy
Different types of therapy also may be helpful, including:

Desensitization 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.

Counseling 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 counselor or sex therapist can help resolve these issues.

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. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.

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 glycerin can promote yeast infections.