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What is Painful Intercourse?

Painful intercourse, also known as dyspareunia, is a medical condition characterised by persistent or recurrent pain in the genital or pelvic area during sexual intercourse. Painful intercourse is more common in women than men and can lead to distress and relationship problems. It can occur due to a variety of factors, with the treatment usually focusing on the underlying cause.

Causes of Painful Intercourse

Painful intercourse can be caused by several factors, including physical factors, psychological factors, or both.

Common physical causes of painful intercourse include:

  • Vaginal dryness due to menopause, childbirth, certain medications, lack of foreplay, or too little arousal before intercourse
  • Infections, such as urinary tract infections, sexually transmitted infections, or yeast
  • Vulvodynia (chronic pain or discomfort around the opening of the vagina)
  • Vaginismus (involuntary tightening of pelvic floor muscles around the vagina)
  • Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
  • Ovarian cysts
  • Uterine fibroids (noncancerous tumours in the uterus)
  • Pelvic inflammatory disease (infection of the female reproductive organs)
  • Vulval skin diseases that cause itching, cracks, burning, or ulcers
  • Trauma or injury from childbirth, hysterectomy, pelvic surgery, or an accident

Common psychological factors that can cause painful intercourse include:

  • Anxiety, fear, shame related to sex, or depression
  • Self-image or body issues
  • Stress, which can cause tightening of the pelvic floor muscles, resulting in pain
  • History of sexual abuse or rape

Symptoms of Painful Intercourse

The defining symptom of painful intercourse or dyspareunia is pain that may occur at the vaginal opening or deep in the pelvis. The pain may be localised and distinct, or there may be a broader sense of discomfort. There may be an aching, burning, throbbing, or ripping sensation along with the primary sensation of pain. There may be pain felt even with arousal prior to any touching.

Diagnosis

Your doctor can diagnose the underlying cause of painful intercourse by conducting:

  • A thorough review of your medical and sexual history
  • Pelvic exam to check for signs of inflammation, dryness, tenderness, or abnormal masses
  • Additional tests, such as a culture test to rule out bacteria or thrush infections, urine test, or allergy test
  • A pelvic ultrasound exam to help detect structural abnormalities, endometriosis, fibroids, or cysts

Treatment for Painful Intercourse

Treatment options aim at relieving the underlying cause of the condition and include:

  • Simple measures: These home remedies could also help alleviate symptoms of painful intercourse:
    • Emptying your bladder before sex
    • Having sex when in a relaxed state
    • Ensuring adequate foreplay
    • If you feel pain or discomfort or begin bleeding with penetration, you should stop penetration - don’t do anything sexual that hurts.
    • Using natural lubricants – coconut oil or “Olive & Bee” lubricant are recommended.
    • Taking an over-the-counter pain reliever before sex
    • Taking a warm bath before sex
    • Applying an ice pack to the vaginal area
  • Pelvic Floor Physiotherapy: Pelvic Floor relxation with a Womens Health Physiotherapist is very important if the vaginal muscles (pelvic floor muscles) are overly tight and tender. Sometimes medical dilators are recommended. They can also help with desensitisation therapy.
  • Medications: Medications can treat pain due to an infection or a vulval or vaginal condition. Low oestrogen levels can cause dyspareunia in some women. Topical oestrogen may help such women who experience vaginal dryness due to low oestrogen levels. Sometimes “neuromodulator” pain medication can be used for vulvodynia or pelvic pain such as Amitryptine (tablets or ointment) or gabapentin.
  • Counselling or sex therapy: In this therapy, you will learn how to improve communication and reestablish intimacy with your partner, with the help of a counsellor or sex therapist.
  • Pelvic Floor Botox: For severe cases of pelvic floor overactivity (tight vaginal muscles) that are not responding to pelvic floor relxation, botox can be injected into the vaginal muscles under a general anaesthetic.

Prevention of Painful Intercourse

There is no specific preventive measure for painful intercourse, however, following certain steps can help reduce the risk of pain during sex, including:

  • Use of lubricants for vaginal dryness
  • Practice safe sex to prevent sexually transmitted infections
  • Engage in adequate foreplay before sex to induce natural lubrication
  • After childbirth, wait for at least 6 weeks before resuming sex
  • Follow proper hygiene
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    Vulval skin care

Related Topics

  • Mater Health
  • UroGynaecological Society of Australasia
  • ANZ Vulvovaginal Society