[This post comes as a result of many questions on painful sex that flood our inbox daily]

What is painful intercourse?

Painful intercourse is persistent or recurrent genital pain that occurs just before, during or after intercourse. It may result from various reasons ranging from physical and medical problems to psychological issues. Many women experience painful intercourse at some point in their lives.

Symptoms of painful sex

The symptoms of painful intercourse may vary between women, but individuals with such conditions may experience one or more of the following:

·Pain with only sexual penetration

·Pain with every penetration, even while putting in a tampon

·Pain with certain partners or just under certain circumstances

·New pain after previously pain-free intercourse

·Deep pain during thrusting, which is often described as "something being bumped"

·Burning pain or aching pain

Causes of painful sex 

These can be considered under deep pain and entry or superficial pain during sex.

Deep pain

Deep pain usually occurs with deep penetration and may be more pronounced with certain positions.

1.Certain illnesses and conditions. The list includes:

a.Endometriosis

b.Pelvic inflammatory disease

c.Uterine prolapse

d.Retroverted uterus

e.Uterine fibroids

f.Cystitis

g.Irritable bowel syndrome

h.Hemorrhoids

i.Ovarian cysts

2.Infections or problems with your cervix: Any infection or problems with the cervix will cause pain during intercourse. This is because they can cause tenderness of the areas around the cervix and deep penetration would cause pain.

3.Surgeries or medical treatments. Scarring from surgeries that involve the pelvic area can cause painful intercourse.

4.Ectopic pregnancy: This is the pregnancy that takes place outside the womb (uterus), usually in the Fallopian tube. Pressure on it can be very painful.

5.Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

6.Emotional factors: Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain.

7.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.

8.Stress. Stress conditions that cause painful sex because they induce tightening of pelvic floor muscles.

9.History of sexual abuse. The majority of women with painful intercourse have history of sexual abuse

Entry or superficial pain

The causes include the following:

1.Insufficient lubrication. Insufficient vaginal lubrication may be due to inadequate foreplay, nervousness, or failure to relax during sexual intercourse. It can also be caused by lowering levels of estrogen after menopause, after childbirth or during breast-feeding as well as certain medications for birth control, high blood pressure and depression. 

2.Injury, trauma or irritation. Injury to the vulva or vagina can occur during rape or sexual assault and later cause painful sex. Others include injury caused by a childbirth tear or the episiotomy cut that is often made during labour.

3.Inflammation, infection or skin disorder. These include infection with vaginal thrush, trichomonas, blisters of herpes and eczema.

4.Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

5.Vulvitis: This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps.

6.Hematoma of the clitoris: This is a bruise (or collection of blood) in the clitoris caused by excessive friction. Can cause painful sex.

7.Urethral caruncle: This is a tender patch that develops at the urinary opening.

8.Vulvodynia: A distressing and long-lasting condition in which the outside part of the sex organs (the vulva) is so sensitive, just touching the area makes the woman jump with pain.

Diagnosis 

Diagnosis of painful sex includes the following:

Medical history: Taking medical history by the doctor may entail asking some questions to enable him or her to make proper diagnosis and ascertain cause. Some of the things the doctor might want to know include:

·Any medical conditions

·When the pain began

·Exactly where it hurts

·How the pain feels

·Whether the pain is situational, all the time, or with a particular sexual partner

·Any previous surgeries

·Childbirth experiences

These will guide the doctor in both the diagnosis and deciding the direction or course of treatment.

Pelvic examination: This involves the doctor checking the vagina and pelvic areas to feel any signs of problems, or infections. A device called the speculum might also be used to help with visual examination of the vagina.

Other tests: Ultrasound and other tests might also be conducted if some abnormalities are discovered during the pelvic examination.

Treatment of painful sex

Treatment of painful sex in women varies and depends on the cause. Some options include:

Vaginal lubricants: These are helpful in cases where the painful sex is due to vaginal dryness and lack of lubrication. They lubricate the vagina and make sex more enjoyable. They are available in different delivery forms such as creams, gels, or suppositories. There are both water-based and oil-based products formulations of lubricants. The water based products are preferred because oil based lubricants interact with latex condoms and cause them to break.

Topical estrogen: Estrogen formulations either applied as a cream or vaginal insert, are very useful in menopausal women. These products can help ameliorate painful intercourse from vaginal dryness or sensitivity making sex more comfortable for these women.

Painful sex after pregnancy can be managed by waiting at least six weeks after childbirth before attempting intercourse. Make sure to practice gentleness and patience.

Medications: For painful sex that is a result of an infection or medical condition, treating the underlying cause may resolve your problem.

Psychotherapy

Psychotherapy can help a woman identify problems in her life that may be responsible for the painful sexual intercourse. Some of these include past sexual or other abuse, or traumatic sexual encounters, attitude towards sex, relationship problems etc.

The goal of psychotherapy is to identify and get rid of these problems.

Sex therapy

The sex therapist identifies problems that may be contributing to the condition, and thereafter, recommends specific exercises to re-focus the individual’s attention and expectations.

Sex therapists may also use or recommend any or combination of the following methods or techniques depending on the need and preferences of the patients:

·Kegel exercises

·Sensate focus exercises

·Cognitive behavioural therapy

Kegel exercises

The Kegel involves squeezing and releasing your pelvic floor muscles which may help ameliorate painful sex.

Sensate focus

This is very helpful when painful sex results from anxiety, nervousness or insufficient foreplay.

Sensate focus is a type of sex therapy that sexual partners complete together. In this kind of therapy, both partners agree to avoid sexual intercourse within a period of time, between few weeks to months as the case may be. During this period, they can practice foreplay- massage, touch or stroke each other, with or without clothes on, but no touching of the genital area (or a woman’s breasts).

After the agreed period of time has passed, when the couple has well explored each other’s body, they can begin touching the genitals and this can ultimately lead to sexual intercourse.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is another form of counselling that may be useful to ameliorate painful sex. This technique basically helps the patient deal with some negative thought pattern, as it is believed that the way you feel is partly dependent on the way you think about things.

The CBT therapist can help identify any unhelpful or unrealistic thoughts that may be contributing to the painful sexual intercourse, for example thoughts about:

• Your self-esteem (the way you feel about yourself)
• Your sexuality
• Your personal relationships

Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.