Painful sexual intercourse (dyspareunia) is a common occurrence, in fact, most women will have experienced it at some point. Some degree of pain is normal during the first few sexual acts, but sex after this phase should quickly progress to an enjoyable and relatively pain-free experience. If you continue to feel notable pain during sex, you should seek medical advice.
Types of Pain
Two distinct types of pain can occur during sex, superficial and deep, although it can be hard to tell which it is.
This is the type of pain experienced the first time you have sex. It may occur solely because of sexual inexperience, inadequate arousal of the female (causing poor vaginal lubrication) or over-vigorous penetration by the man.
A lack of the female sex hormones that normally maintain the strength and lubrication of the vagina can result in painful sex. This can happen after delivery especially if you’re breastfeeding, or after the menopause.
Swellings around the vaginal opening (such as Bartholin’s cysts and abscesses) can also cause pain. A small number of women have no detectable physical causes. They may have psychological factors (as with vaginismus) that make it impossible for the male to penetrate the vagina because of ‘vaginal spasms’.
This is felt as pain deep inside the vagina and lower tummy. It may be experienced during or after the sexual act and is usually due to a physical factor, some of which are unavoidable.
About 1 in 6 women have wombs that tilt backwards, and some have very mobile ovaries. The ovaries or womb can lie directly over the upper end of the vagina, putting them ‘in line’ of the penis during deep penetration and resulting in discomfort.
The most common reason for women to experience deep pain during sex is pelvic infections. Not all pelvic infections are obvious and some women may have them without realising. These infections are usually sexually transmitted, but may also result from appendicitis and pelvic surgery.
How Is It Investigated?
Specific investigations include vaginal and urethral swabs for infection, pelvic ultrasound for swellings and sometimes laparoscopy to view the insides of the tummy and pelvis.
How Is It Treated?
Once the causes are determined, treatment options will be discussed with you to ensure the right course of action is taken. This is a very personal subject, and the treatment will be entirely in line with you and your partner’s lifestyle and beliefs.
Inexperienced couples and women with ‘vaginismus’ will benefit from psychosexual counselling. This will help couples experiencing vaginismus maintain some degree of sexual functionality. The combination of hormone replacement therapy, vaginal lubricating gels or creams, and gentle intercourse will help women after childbirth or the menopause. Infections will need to be treated by antibiotics or other appropriate medicines. Unresolved injuries and swellings may need to be dealt with by surgery.
Women with wombs that are tilting backwards and those with very mobile ovaries may also benefit from psychosexual counselling that includes education about alternative positions for sex. Pelvic infections will need to be treated by antibiotics and these may need to be given to both partners. Medicines and/or surgery may be used to treat endometriosis, fibroids, adenomyosis and ovarian cysts.