Every now and then, a patient will walk into my clinic with a “difficult” issue. At first, she will be quite reluctant to talk about it, but as I probe further, she will eventually reveal that she has been experiencing problems with her spouse due to painful sexual intercourse.
Pain during intercourse is also known as dyspareunia. For many women, it is not easy to talk openly about this problem as sex is not often discussed publicly in our culture. Not only is it a very personal issue, it also relates to a woman’s self-esteem and confidence in her relationship with her partner. However, pain during intercourse should not be swept under the carpet, as the physical pain will not go away and it will lead to emotional and relationship problems further down the road.
Don’t lie back and accept it
The first step to addressing the problem is accepting that the problem exists. Painful sex is a complex issue and isn’t the same for everyone. Some women may experience some discomfort occasionally, while others experience pain, or what they classify as pain. Some women feel pain during penetration, but others may even experience pain with sexual touching.
Painful intercourse is not a straightforward condition with black-and-white causes and symptoms. Therefore, to address it, you have to be open with yourself, your partner and your doctor, in order to figure out what causes it and how to overcome it. Ask yourself: When did sex start to hurt (has it always hurt)? When does the pain begin (is it as you’re getting excited, only during penetration, related to orgasm)? Where do you feel the pain (is it in one specific area, or more general)? Are there still things you can do sexually that don’t cause pain? Your doctor will be able to help you think about the possible physical or psychological causes of painful sex.
Physical causes of painful sex
The most common physical cause of painful intercourse is vaginal dryness, caused by lack of lubrication. There are all sorts of reasons women experience vaginal dryness, but using a personal lubricant can be an easy and effective way to treat this problem and eliminate a major cause of painful sex. It also helps to relax during intercourse and increase the amount of foreplay.
There are also a myriad of conditions that can result in painful intercourse:
- Vaginismus – This is a common condition where the vaginal muscles go into spasms, mainly caused by the fear of being hurt.
- Vaginal infections – Infections like a yeast infection can cause soreness and discomfort during intercourse.
- Problems with the cervix – Any condition or infection affecting the cervix can cause pain during deep penetration (where the penis reaches the cervix).
- Problems with the uterus and ovaries – If there are fibroids or cysts in the uterus or ovaries, these can cause pain during deep penetration.
- Endometriosis – This is a painful condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
- Pelvic Inflammatory Disease – In PID, the tissues deep inside become severely inflamed and the pressure of intercourse causes deep pain.
- Ectopic pregnancy – This is a pregnancy where a fertilised egg develops outside of the uterus.
- Menopause – Older women experience vaginal dryness because the vaginal lining can lose its normal moisture when menopause sets in.
- Intercourse too soon after surgery or childbirth – Surgery or childbirth causes trauma to a woman’s body, so she needs time to heal before resuming intercourse again.
- Sexually transmitted diseases – STDs can include genital warts, herpes sores or other infections that cause vaginal pain and soreness.
- Injury to the vulva or vagina – These injuries may include a tear from childbirth or from a cut (episiotomy) in the perenium (area of skin between the vagina and the anus) that is made during labour.
Psychological causes of painful sex
Some causes of painful intercourse are psychological, although this does not mean that you are crazy or that it isn’t real. Some women (and men) have only had coercive or violent sexual experiences, such as sexual assault or abuse. When your sexual experiences have never been consensual or pleasurable, it isn’t surprising that your body doesn’t learn to enjoy sex (even if you are with a partner whom you like or love).
Part of this is due to the way your mind anticipates pain. If you experienced pain during sex previously (whether due to assault, a physical condition or a wrong position), you will begin to anticipate pain the next time you have sex. First, you will probably be less tuned into what’s going on in your body, and you may find your arousal is lowered along with less lubrication. Anticipation can also make the pain feel more intense, because your body may be tense and result in more pain.
Overcoming this psychological block requires support and therapy so that you will learn to experience a positive sex life again. Another psychological factor that leads to painful intercourse is lack of interest in sex. There are times when each of us are not in the mood to have sex, even though our partners are. For women, this can result in painful sex because of low arousal and lack of vaginal lubrication.
Can sex ever be good again?
The most important thing to know is that sex doesn’t have to hurt. Just because you have had painful sexual experiences before, it does not mean that it always has to be this way. Some physical conditions require simple interventions, such as the use of water-based lubricants or prescription medications. Some conditions may require sexual therapy, especially if abuse is involved.
Most importantly, communicate with your partner. It can be difficult to talk about sex, especially when it’s not going well, even for couples who have been together for years. However, ignoring it can sometimes make things worse, as it leads to emotional problems and compounds the tension.
Be honest, patient and creative – you will find a way to enjoy sex again without the pain. And being open about your sexual relationship will eventually lead to a better sex life than before.
The Star Newspaper,May 8, 2009
By Dr Nor Ashikin Mokhtar