Painful intercourse (dyspareunia)

Sex is meant to be an enjoyable

and happy experience. If you

get pain, it isn't.

Do you get pain during intercourse? If so, then the odds are that you're a woman – though at the end of this article, you'll find advice for the small number of men who get intercourse pain.

A lot of women experience sexual pain. A recent Swedish survey suggested that it occurs in 9.3 per cent of females, with the incidence being higher among the young and inexperienced and relatively low among the over-50s.

It's not much fun having pain during intercourse. After all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.

Fortunately, the trouble will often resolve if the man takes more time with love play so that the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like Eros or Liquid Silk.

When to seek help

You can safely disregard one isolated episode of pain during sex. After all, it's easy to feel pain when a sensitive part of you is being prodded quite hard.

But if the pain keeps on happening, you shouldn't feel you have to put up with it. Get something done to improve things.

How? If you know that your GP is skilled at dealing with these matters, then he or she would be a good person to consult. But we have to admit that most family doctors are not trained in dealing with pain during intercourse.

It might be more realistic to go to your local family planning clinic. Many family planning clinic doctors (usually women) have spent a long time being trained by the Institute of Psychosexual Medicine (IPM) to deal with this type of pain.

Unfortunately, family planning clinics have become rather swamped with patients needing help, and they don’t have as much time as they used to for helping women with intercourse difficulties.

An alternative is to see a female IPM-trained doctor privately. There are also excellent NHS psychosexual clinics in some parts of the country - notably Sheffield, Preston, Paddington and Tooting.

A very good low-cost sexual counselling service is provided by both Relate and Relationships Scotland – formerly known as Relate Scotland.

Sometimes, simple advice about sexual 'positioning' can help.

At a medical conference in 2011, Dr Peter Greenhouse of the Bristol Sexual Health Centre revealed that many patients with intercourse pain due to endometriosis can benefit from positions that avoid deep penetration, such as the 'spoons' position or the 'male astride' one.

The emotional factor

In a minute, we'll look at the possible causes of intercourse pain, or dyspareunia, to give it its medical name. But it's important to realise that there is often usually some emotional element in this problem.

If you experience pain during sex, it's almost certain to be distressing for you. This distress may well make you tighten up down below. And this tightening up will very likely make the pain worse next time.

Unfortunately, painful intercourse can often have a destructive emotional effect on a relationship. Sometimes couples split up because of it. So that's a clear reason why you should get the problem sorted out as soon as possible.

What causes it?

There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious, but a few are.

Ideally, the assessment should be done by a doctor who is skilled in the technique of vaginal examination.

One of the first things to establish is: is the pain deep inside you? Or is it near the outside?

This may not be easy for you to say. Sometimes a pain is both superficial (near the outside) and deep. But deciding which it is can help sort out what's wrong.

Vaginismus

Vaginismus can cause both deep and superficial pain, and it's a common cause of trouble during sex. It's a spasm of the vaginal muscles, caused mainly by fear of being hurt.

This spasm is often so painful that intercourse is impossible – sometimes for years.

Some women with vaginismus have never been able to have full sex or even use tampons. They also tend to be very fearful of vaginal examinations and so may never have had a smear test.

Vaginismus arouses strong emotions, and women who have it are often very angry with partners, doctors and themselves. But the condition is no one's fault.

Common causes include:

a restrictive upbringing, in which the woman was brought up to view sex as nasty or dirty.

an upbringing in which the woman was given the idea that the vagina is very narrow and so sex must be very painful.

a history of rape or childhood sexual abuse. Experiences like these understandably make women fearful of sex and of being hurt.

a medical history of painful vaginal infections.

unease with the partner – perhaps at an unconscious level.

It is a common misconception that women with vaginismus dislike sex altogether.

In fact, many women with this condition enjoy closeness with their partners.

Many get great pleasure from love play and some are able to reach orgasm in this way. But the enjoyment ceases when penetration is attempted or suggested.

In the UK, women doctors who have been trained by the Institute of Psychosexual Medicine have by far the greatest experience of treating vaginismus.

What are the other causes of deep pain during sex?

Problems with your cervix: the man's penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called 'collision dyspareunia'.

Womb trouble: various womb disorders, including fibroids, can cause deep intercourse pain.

Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times. The pressure of the penis on an area of endometriosis may cause intense, deep pain.

Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.

Pelvic inflammatory disease (PID): this is caused by infection, and has become more common in the UK largely thanks to the bug called chlamydia. If chlamydia isn't treated, there is quite a chance of PID developing. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.

Ectopic pregnancy: this means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful.

What are the other causes of more superficial pain?

Lack of lubrication

This can be due to nervousness, hang-ups and failure to relax. Unskilled foreplay by the man is a common cause, especially when it doesn't go on long enough. (Many women would like half an hour – but don't get it!)

Well-endowed partner

Some women complain that their partner’s penis is too big.

In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so any female should be able to accommodate any male.

But being unused to a larger man or previous problems with bladder infections or endometriosis can lead to anxiety and tension about sex.

A recent invention may be of use here. It's called the 'Come Close' and is a kind of cushioned ring that the man wears on the base of his penis. This reduces the length of the penis that goes into the vagina. For more details, visit: www.comeclose.co.uk. Currently, the 'Come Close' retails at £24.99.

Menopausal or post-menopausal dryness

This is usually due to a fall in female sex hormones. Treatment with HRT pills or hormone cream will usually put matters right. Ordinary sex lubricants will help, too.

Vaginal infections

These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas. The blisters of herpes can also be really painful.

Injury

Injury to the vulva or vagina can occur during rape or sexual assault and later cause dyspareunia.

Much more commonly, injury is caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.

Genital warts

These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.

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.

Haematoma of the clitoris

I first encountered this about 30 years ago, but it's still not widely known. It's a bruise (or collection of blood) in the clitoris, caused by excessive friction. It nearly always gets better within a few weeks.

Occasionally, the clitoris spontaneously 'bursts open', releasing some blood. It should heal up again rapidly, but it's best to have it checked by a doctor.

Urethral caruncle

This is a tender patch that develops at the urinary opening.

Foreign body in the vagina

The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon causes an infection.

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.

Its cause is not yet known, but it can often be successfully treated.

The experts in dealing with it are the doctors at genitourinary medicine (GUM) clinics.

Cancer

This is a rare cause of intercourse pain, but it must be borne in mind for a woman who develops this kind of pain for the first time after the age of 40.

Does intercourse pain affect men?

Sometimes men experience pain during intercourse.

Common causes are skin disorders on the penis such as eczema or psoriasis.

It can be that the woman's vagina is too tight for her partner. A good sex lubricant can help here.

Occasional causes of male pain include:

thrush – in which case the female partner will probably have thrush too

a forgotten stitch left in the woman's vagina after childbirth
an IUD thread or a displaced IUD in the vagina

Peyronie's disease – a male disorder that causes bending of the penis.

Summing up

Whether you're female or male, you shouldn't disregard pain occurring during intercourse. If it happens more than once, it's time to see an experienced doctor. Very often, the problem is curable.