aLife Singapore | Pain During Sex (Dyspareunia)
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07 Apr Pain During Sex (Dyspareunia)

For women, pain can occur in the pelvic area during sexual intercourse. This is called dypareunia. The pain may be superficial at the entrance of the vagina, or deep with penetration on penile thrusting. Some women may also experience severe tightening of the vaginal muscles with penetration, a condition called vaginismus. If left untreated, it may lead to loss of interest (libido) in sexual activity.

Common causes

  • Endometriosis: a common cause for pain during sexual activities. Sexual intercourse causes movement and stretching throughout the pelvis. Normally this movement is comfortable. However, with endometriosis, the thickened tissues surrounding the womb and the ovaries generate pain instead.
  • Vaginismus — involuntary contraction of the vaginal muscles usually resulting from psychological trauma of sexual abuse or rape.
  • Vaginal dryness or inadequate lubrication from insufficient foreplay.
  • Intercourse too soon after surgery of vagina or child birth.
  • Vaginal infection including herpes sores, genital warts, or other sexually transmitted diseases such as Chlamydia and gonorrhoea. They can remain dormant (asymptomatic) and go undiagnosed for years, only to cause damage and pain later. They affect the fallopian tubes and the ovaries and can render a woman sterile.
  • Ovarian tumour or cyst: If the tumour is hit with thrusting during deep penetration, it causes pain.
  • Urinary tract infections
  • Allergic reaction to condom, clothing, spermicides or douches
  • Menopause (vaginal lining loses its normal moisture and becomes dry and thin)
  • Genital irritation from soaps, detergents, douches, or feminine hygiene products.

Medical and sexual history and physical examination will help the gynaecologist determine the cause. It is difficult to imagine other explanations for the pain if the woman is adequately aroused before and during intercourse. Her uterus should elevate out of the way and not cause her pain, even with deep thrusting during intercourse. And she should not feel pain in her vagina from friction, if she is well lubricated from either her own arousal or the use of a lubricant.

Distinguishing superficial pain from pain that occurs with deeper penetration may give a clue to the cause of dypareunia. Duration and timing of pain are also important. Attitudes towards sex in general, recent emotional event, past traumatic event including rape and child abuse may help in the diagnosis.

Treatment

Treatment depends on the cause.

For painful intercourse in women after delivery:

  • Wait at least 6 weeks after childbirth before resuming sexual relations.
  • Be gentle and patient when resuming sexual intercourse.

For vaginal dryness/inadequate lubrication:

  • Adequate foreplay and stimulation of clitoris may help to ensure proper lubrication of the vagina.
  • The use of a water-soluble lubricant like K-Y Jelly may help. Vaseline should not be used as it is not water soluble and may encourage vaginal infections.
  • Good hygiene helps to some degree.
  • Antibiotics or antifungal medications may be required for urinary tract infections, sexually transmitted diseases, or vaginal infections.
  • Yeast infection can be reduced by avoiding tight clothing, wear cotton underpants and practice good hygiene. Change panty after prolonged sweating. Change into dry clothing promptly after swimming.
  • Bladder infections can be prevented by drinking plenty of water, wiping from front to back after using the toilet, and urinating after sexual intercourse.

Sex therapy and counselling may be helpful, especially if no underlying medical cause is identified. Guilt, inner conflict, or unresolved feelings about past abuse may be involved, which need to be worked through in therapy.

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