Persistent painful sex is medically known as dyspareunia. There are many known causes of painful sex. It’s important to know that it’s not normal to experience persistent painful sex. Paying attention to your body during sex will help you understand the potential cause. Discussing the details of your pain during sex will also help a healthcare provider guide you through a diagnosis and treatment plan.
The healthcare provider knows the long list of potential causes of painful sex. Getting a detailed history and performing a gynecologic examination will help make the diagnosis more clear to a trained physician. Other health care providers including a sex therapist and a pelvic health specialist/physical therapist is often necessary to help treat the underlying condition.
Why does vaginal dryness cause pain with sex?
The natural lubrications of the vagina can dry up with prolong sexual contact and penetration causing friction and pain. If you haven’t had the right amount of foreplay to become sexually aroused and “get wet”, the vagina will be dry making sex painful when the penis or fingers enter the vagina. KY, Astroglide and extra virgin coconut oil are great additions to long periods of intimacy. Dryness can also occur in menopausal women who are not taking any estrogen which results in a burning sensation inside the vagina, especially with sex contact and penetration.
How can endometriosis cause pain during sex?
Some women with endometriosis may experience pain with sex depending on where the endometrial implants are located in the pelvis. If the implants are on nerves, ligaments and tissue stretched during sex, pain can be significant and, often, unbearable lasting hours and days afterwards making sex impossible. The pain during sex can be so horrible that many women will not be able to have sexual penetration. This can have permanent mental and physical consequences on a sexual relationship.
Pain with Sex
Pain with sex is not normal. There are many causes of pain with sex including:
Vaginal dryness-If you have not had the right amount of foreplay –to become sexually aroused and “get wet”– the vagina will be dry making sex painful when the penis enters the vagina. A sexually lubricate and appropriate foreplay is your best bet in preventing vaginal dryness.
Menopause-Vaginal dryness can also occur in menopausal women who are not taking any estrogen which results in a burning sensation inside the vagina, especially with sex. Sexual lubricants, estrogen cream and Osphena, a non-estrogen oral therapy, can help with some of these problems related to dryness due to menopause.
Vaginal Infection-If you are noticing signs and symptoms of a vaginal infection—vaginal discharge, odor, or itching, this can lead to pain and swelling with sex. A trip to your health care provider will make the diagnosis.
Pelvic Inflammatory Disease (PID)-Sexually transmitted infections such as Chlamydia and Gonorrhea are the typical culprits of this serious pelvic infection that can lead to infertility. Getting STI checkups is so important when you are change partners.
Penis Size- “Bigger is better” is not the case for a vagina that can’t tolerate a long and thick penis. The average penis is 5.1 inches in length and 4.8cm in diameter (girth). When flaccid (not erected) the average penis measures between 3 and 5 inches. When erect the average penis measures between 5 and 7 inches. The vagina does stretch depending on the size of the penis but it may take time, patience and open communication.
Vaginal Tears and Lacerations-Tears and lacerations can occur with sex if you are not lubricated enough, if your partner has a large in girth and/or length penis, sex toys and trauma from childbirth. Sexual lubricants, open communication with your partner and patience helps avoid some of these problems.
Latex Allergy-The majority of condoms are made out of latex. Some women have a latex allergy which can cause vaginal swelling, itching and pain during and up to 36 hours after sex. If you have a latex allergy you can use the polyurethane condom as an alternative for “safe sex” and avoid this allergic painful reaction.
Ruptured Ovarian Cyst-If you are having sex during ovulation or “mid-cycle” chances are there is a expected large ovarian cyst waiting to ovulate and release the egg. Aggressive sex can cause this cyst to rupture, releasing its fluid contents along with the egg, and causing pain. A pelvic ultrasound and your menstrual history help make the diagnosis.
Endometriosis and Uterine Fibroids-Both of these female problems can cause pain with sex especially with deep penetration. A pelvic ultrasound and discussing other related symptoms with your health care provider are useful in making the diagnosis.
Positional Sex- Certain sexual positions are known to be anatomically harder on the vagina and female organs including the uterus and ovaries. The “Missionary” position tends to be easier for women and their anatomy whereas “Doggie Style” or from behind, allows for deeper penetration for the male but more discomfort and pain for many women. It’s completely normal for women to experience pain or cramping during sex depending on certain sexual positions. Learn and know what positions are less uncomfortable and painful during sexual intercourse with your partner.
Virginal-If you have never had vaginal penetration with a penis your first experience with sex will probably be painful. It may take time and regular sex before you start to experience pleasure. A good lubricant and sometimes a numbing gel, lidocaine, at the entrance of the vagina help relieve this common problem. Good communication with your partner and patience is the right recipe for success.
Vaginismus-This is an involuntary spasm of the vaginal muscles at the entrance to the vagina. The intense vaginal spasm causes pain and the inability of the penis to enter the vagina. Physical therapy, psychotherapy and medication help in dealing with this female condition.
Emotional Problems-Feeling depressed, anxious, having relationship problems and fear of intimacy all play a role in getting sexually aroused and contribute to painful sex. Psychotherapy and communicating your feelings to your partner help overcome some of these struggles.
History of Sexual Abuse –Any history of sexual abuse and trauma (emotional or physical) can make you have an aversion or dislike to sex. The devastating experience often leads to “post-traumatic stress disorder” which only allows you to feel pain with sex. Therapy and open communication with your current partner is the key to helping resolve this challenging problem.
Most importantly, talk to your health care provider about any problems you are having with intimacy, achieving an orgasm or having pain with sex.