Pain during Sex

Pain during Sex

Pain during sex – Shall we talk about it?

Dyspareunia or painful sex can be very distressing to couples. The pain can be experienced just before ( superficial), during or after (deep) sexual intercourse. This can happen to both sexes, but it is usually more common in women.

Unfortunately many people who suffer from this condition do not seek medical attention and suffer in silence. Not only it can potentially affect the relationship with your partner, it could be a sign of an underlying medical condition that may potentially cause complications if untreated.

Superficial/ Entry dyspareunia

This condition is associated with history of pain upon vaginal entry. This is commonly associated with vaginismus and  inadequate lubrication from incomplete sexual arousal.

Vaginismus is involuntary vaginal muscle spasm, which results in any kind of vaginal penetration painful or impossible. Negative perceptions about sex is linked to this condition. Counselling and trial of vaginal dilators are proven helpful in such situations. Patience and mutual understanding from partner is also essential to overcome this.

Vaginal atrophy due to inadequate estrogen as a result of menopause can result in significant vaginal dryness and friction resulting in entry dyspareunia. Topical estrogens can be useful to relieve the symptoms. 

Entry pain is also suggestive of common vaginal infections such as fungal and bacterial vaginitis, ulcerations from herpes simplex virus ( HSV), and Human papilloma virus ( HPV) infections. Hence, a thorough phyisical examination and  swab test are important to diagnose these infections. 

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Deep Dyspareunia

As we mentioned earlier, pain may occur before entry, with entry or once the penis is in the vagina. When pain is associated with deep thrusting, this is often caused by conditions such as endometriosis ( in which tissue that normally lines the inside of your womb, starts to grow outside your womb, commonly involving the ovaries, bowel and other pelvic structures),  endometritis (inflammation of the lining of the womb – usually caused by infection) and pelvic inflammatory disease ( PID).

Endometriosis is also an important cause of chronic painful periods. If this condition is not picked up early, it can potentially affect the women’s fertility.

90% of all cases of pelvic inflammatory disease are caused by untreated sexually transmitted infections, mainly chlamydia and gonorrhea. Increasing numbers of women become infertile or develop ectopic pregnancies ( pregnancies out of the womb) as a result of PID. Women with chlamydia and gonorrhea may have no symptoms. Therefore it is important for sexually active women to be screened for these infections.

Occasionally dyspareunia can be the initial presentation of an early urinary tract infection with accompanying urinary symptoms such as pain during urination and frequency.

What should I do? 

Pain during sex is not always normal and women should not suffer in silence. Dyspareunia can potentially affect relationships. If you are unable or no longer enjoy sex due to pain, you should seek medical advice as this could be a sign of an underlying untreated medical condition. 


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