What Women Need to Know About Pain During Sex

CS-Blog

Cedars-Sinai Blog

Sep 12, 2018
Cedars-Sinai Staff

Pain during sex is a common problem for women.

As many as 75% of women will experience pain during sex at some point, according to the American College of Obstetricians and Gynecologists. For many women, the pain is rare or happens only once, but for others it’s persistent.

“Some women may have experienced sexual joy, but then at some point in their life, it becomes painful,” says Dr. Karyn Eilber. “They may stop having sex with their partners. Whether your pain is mild or severe, if it bothers you and it’s inhibiting you from having sex, you should definitely talk to you doctor. “

Dr. Eilber and Dr. Alexandra Dubinskaya treat women with sexual dysfunction and study its causes. Here’s what they think women should know about painful sex:

“Like mental health, sexual health can carry a stigma. Mental health is slowly losing that stigma, and sexual health needs to follow that trend. We can look at these things as health conditions and normalize having these conversations as part of our regular healthcare.”

Sex isn’t supposed to hurt

Sexual health is worth prioritizing

Read: How to Address Uncomfortable Topics With Your Doctor

Dryness is a common cause of pain during sex

Read: Endometriosis Q&A with Dr. Kelly Wright

Many conditions may cause pain during sex

Dryness is the most frequent reason, but there are many other reasons sex might become painful. Some conditions that can be at the root of the problem:

• Endometriosis: In people with endometriosis, the tissue that normally lines the uterus grows in other areas of the pelvis, such as the ovaries, fallopian tubes, or intestines. The condition can be painful, including causing pain during sex.
• Interstitial cystitis: Also known as painful bladder syndrome, this condition is often mistaken for a urinary tract infection because it shares many of the same symptoms such as bladder and pelvic pain, pressure, and a frequent urge to urinate. However, the condition is not an infection.
• Pelvic floor dysfunction: The pelvic floor muscles—the ones you tighten when you want to stop passing urine quickly—can become painfully tight. It can cause an achy pelvis and pain with any kind of insertion.
• Pelvic floor injury: An injury to the pelvic floor, which can have many causes from vaginal childbirth to improperly fitted bicycle seats, can cause pain during sex.  
• Vaginismus: The muscles at the opening of the vagina become tightly contracted, making penetration impossible.
• Vulvodynia: Chronic pain at the opening of the vagina, including burning, stinging, soreness, itching, rawness and pain during sex.
• Infections: Bacterial, yeast or sexually transmitted infections can cause pain during sex and usually have other symptoms, such as discharge.
• Ovarian cysts: These fluid-filled sacs on the ovaries often have no symptoms. When they rupture, they can cause pain and bleeding.
• Fibroids: These non-cancerous growths on the uterus can cause heavy menstrual bleeding, pelvic pressure, pain, and painful intercourse.

Read: Polycystic Ovary Syndrome Q&A with Dr. Jessica Chan

Don’t suffer in silence

Painful sex usually has a cause, and once it’s identified, it’s likely treatable. If you’re avoiding sex, it’s time to see your doctor. Your gynecologist is often the best place to start, as they’re likely to be able to accurately diagnose the cause of the pain. 

Many women are reluctant to talk about any issues they’re having in the pelvic region, whether it’s a prolapse, incontinence or painful sex. Many don’t open up to friends or loved ones about these issues, and as a result, these problems seem kind of mysterious to the average person.

“I think as women, we often tend to blame ourselves,” Dr. Eilber says. “That can definitely contribute to the pain and to sexual dysfunction. I think the more resources we can make available, and the more we’re able to talk openly about these issues, the more beneficial it will be.” 

Read: Reclaiming the Joy of Sex

Female Pain During Sexual Intercourse (Dyspareunia): Causes & Treatments

Written by WebMD Editorial Contributors

• What Causes Painful Sex in Women?
• How Can Painful Sex In Women Be Treated?

Intercourse pain, or dyspareunia, can cause problems in a couple’s sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant.

In some cases, a woman can experience painful sex if one of the following conditions is present:

• Vaginismus. This is a common condition. It involves an involuntary spasm in the vaginal muscles, sometimes caused by fear of being hurt.
• Vaginal infections. These conditions are common and include yeast infections.
• Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.
• Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.
• Endometriosis. This is a condition in which the tissue similar to that which lines the uterus grows outside the uterus.
• Problems with the ovaries. Problems might include cysts on the ovaries.
• Pelvic inflammatory disease (PID). With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.
• Ectopic pregnancy. This is a pregnancy in which a fertilized egg develops outside the uterus.
• Menopause. With menopause, the vaginal lining can lose its normal moisture and become dry.
• Intercourse too soon after surgery or childbirth.
• Sexually transmitted diseases. These may include genital warts, herpes sores, or other STDs.
• Injury to the vulva or vagina. These injuries may include a tear from childbirth or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.

• Vulvodynia. This refers to chronic pain that affects a woman’s external sexual organs — collectively called the vulva — including the labia, clitoris, and vaginal opening. It may occur in just one spot, or affect different areas from one time to the next. Doctors don’t know what causes it, and there is no known cure. But self-care combined with medical treatments can help bring relief.

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.

Some treatments for female sexual pain do require a doctor’s care. If vaginal dryness is due to menopause, ask a health care professional about estrogen creams or other prescription medications. Other causes of painful intercourse may also require prescription drugs.

For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding past abuse.

Call a doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. Ask for a referral to a certified sex counselor if there are other concerns that need to be addressed.

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Pain during intercourse: causes, diseases in which it develops, methods of diagnosis and treatment.

Definition

Pain and discomfort during intercourse (dyspareunia) refers to extremely unpleasant and painful sensations that occur in the genitals during coition. The reaction to this pain is so pronounced that it makes a person refuse sexual intercourse. Fear of pain causes muscle spasm, which does not allow you to enjoy intimacy, is accompanied by impaired blood circulation in the pelvic organs and dystrophic changes in tissues.

The vicious circle of psychogenic and organic changes largely determines the ineffectiveness of treatment when using only drug therapy.

Types of pain during intercourse

Pain during intercourse can vary in intensity and character. Depending on the nature of the disease, moderate diffuse (diffuse) pain or a feeling of heaviness in the lower abdomen, a feeling of spasm, burning, itching may prevail. Rarely, widespread severe pain in the uterus or lower abdomen can be observed.

Pain is differentiated by localization (at the entrance to the vagina or deep pain in the uterus), time of occurrence (at the beginning of coition, during the active phase or after intercourse), situational (only with a certain partner or only in a certain position).

Regardless of the localization and nature of the pain, it is always accompanied by negative emotions, forcing fear and hostility towards sexual intercourse.

Possible causes of pain during intercourse

The international classification of diseases distinguishes two causes of pain syndrome – organic (associated with diseases of the genitourinary tract) and psychosomatic (the primary link is associated with a psychological disorder).

Organic dyspareunia in women

In women, the pain may be caused by vaginismus, or spasmodic contraction of the muscles in the vagina when the penis enters. The cause of vaginismus most often lies in a negative attitude towards sex, caused by previous stress, pain or rape.

Less commonly, dyspareunia occurs after trauma to the genitals, childbirth, or pelvic surgery. According to statistics, more than a quarter of women experience pain after a caesarean section, as well as many nursing mothers.

Pain followed by contraction of the vaginal muscles can be caused by insufficient amount of lubricant (lubricant) in the absence of arousal at the beginning of sexual intercourse, as well as due to atrophy of the vaginal mucosa due to a decrease in estrogen (female sex hormone) levels in women during menopause.

A decrease in estrogen levels and dryness of the vaginal mucosa can be the result of chemotherapy and radiological therapy.

Inflammation of the mucous membrane of the vulva is associated with atrophic tissue changes due to impaired carbohydrate metabolism and estrogen deficiency. Diabetic vulvitis is characterized by the standard signs of inflammation – redness, swelling and pain during sexual intercourse.

Vulvodynia (vulvar vestibulitis) is also a common cause of dyspareunia, where pain occurs when the penis enters the vagina. This condition is explained by a multiple increase in the transmission of impulses from the receptors of the vagina to the brain. With such sensitivity, even a slight irritation is perceived by a woman as a strong and unbearable pain. Sometimes such pain can be provoked by vulvovaginal candidiasis and papillomatosis.

Painful intercourse is observed when there are pathological processes in the urethra and bladder. So, interstitial cystitis (painful bladder syndrome) in almost half of the cases is accompanied by dyspareunia, which makes women see a doctor. Pain in this case occurs not only during intercourse, but also when the bladder is full, and its peak occurs at the time of the urge to urinate.

Pelvic pain, one of the manifestations of which is dyspareunia, is characterized by constant or cyclic painful, pulling sensations in the sacrum, lower back or lower abdomen. This condition may be due to both a gynecological disease and may not have an obvious organic basis. Most often, dyspareunia in the composition of pelvic pain occurs in patients with endometriosis, while they also complain of pelvic pain, dysmenorrhea (severe cyclic pain in the lower abdomen) and heavy menstruation.

Pelvic pain and dyspareunia sometimes occur with the pathological position of the uterus (uterus bend, retroversion of the uterus), weakening the tone of the pelvic floor.

Congestive and inflammatory changes in the pelvic organs lead to adhesive processes, which aggravates the pain syndrome.

Organic dyspareunia in men

In men, the most common causes of pain during intercourse are inflammatory diseases of the prostate and urethra.

The pain usually occurs at the time of ejaculation. If the pain syndrome accompanies the moment of erection, it can be caused by inflammation or loss of elasticity of the foreskin.

Dyspareunia is often a symptom of urinary tract infections such as urogenital chlamydia. At the same time, there may be discharge from the urethra, painful urination, and symptoms of epididymitis (inflammatory disease of the epididymis) or prostatitis (inflammatory disease of the prostate gland).

Fibrous plaques in the albuginea and cavernous tissue of the penis in Peyronie’s disease cause deformation of the penis during erection, which is accompanied by painful sensations during intercourse.

Psychosomatic dyspareunia

In addition to the organic nature, dyspareunia also has psychogenic causes: improper sexual education, psycho-emotional trauma, delayed psychosexual development, unfavorable beginning of sexual life. Often, patients have a history of gynecological and urological diseases that are characterized by a long course. Psychosomatic dyspareunia can also be accompanied by pathology of the genital organs, but their severity is low and most often represented by only minor changes.

Which doctors to contact for pain during intercourse

Dyspareunia combines a complex of problems, the solution of which can be provided by the joint work of doctors.

Typically, a woman who experiences pain during intercourse goes to
a gynecologist, however, treatment without taking into account psychosomatic disorders may be ineffective, therefore it is recommended to include a sex therapist in therapy.

A man who experiences pain during intercourse should contact
urologist.

Diagnosis and examination of pain during intercourse

Diagnosis of the disease that caused dyspareunia is difficult and usually involves several stages.

First of all, a thorough medical history is needed, which allows you to identify not only the nature and location of pain, but also the time of its onset (from the very beginning of sexual activity, after childbirth or surgery, with the onset of menopause, etc.). It is very important to assess psychosocial factors – stress during the first sexual intercourse, cases of unwanted sex, violence, dissatisfaction with family life, lack of libido.

After taking a history of women, an examination of the external genitalia is performed, which allows visualization of areas of redness, signs of candidiasis or vaginosis. The doctor also conducts a digital or bimanual (two-handed) examination, in particular, this is necessary to detect vaginismus and vulvodynia. If discharge is present, a Pap smear, wet-slide microscopy, and culture are required.

Culture of genital secretions for microflora, determination of sensitivity to antimicrobials and bacteriophages

Bacteriological examination of biomaterial for the purpose of isolating and identifying opportunistic pathogens – pathogens of non-specific infectious diseases…

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If endometriosis is suspected, your doctor may order a colposcopy, ultrasound, magnetic resonance imaging, or computed tomography.

Colposcopy

Examination to assess the condition of the mucous membrane of the vagina and cervix and diagnose pathological changes, including neoplasms in the early stages…

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US examination of pelvic organs (uterus, adnexa)

Ultrasound scanning of the organs of the female reproductive system to assess the shape and size, as well as exclude pathology.

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MRI of the pelvis and external genitalia

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The diagnosis of “interstitial cystitis” is made sequentially after the exclusion of pathology from the bladder. Clinical and biochemical blood tests are required, as well as a blood test for antibodies to the herpes simplex virus, cytomegalovirus.

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a…

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Creatinine (in the blood) (Creatinine)

Synonyms: Blood test for creatinine; Serum creatinine; Serum creatinine, GFR estimate. Creat; Cre; Blood Creatinine; Serum Creatinine; Serum Creat.
Brief characteristic determined …

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Avidity of IgG antibodies to herpes simplex virus types 1 and 2

Herpes simplex virus (HSV) infection is part of a group of reproductively significant infections referred to as the TORCH complex

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Avidity of IgG antibodies to cytomegalovirus (anti-Cytomegalovirus avidity, anti-CMV-IgG avidity)

Cytomegalovirus infection is included in the group of reproductively significant infections, referred to as the TORCH complex (the name is formed by initial letters in Latin . ..

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In addition, microscopic and bacteriological examination of urine, smears from the urethra and cervical canal, ultrasound examination of the kidney and bladder, as well as excretory urography, CT of the urinary tract and cystoscopy of the walls of the bladder are carried out.

General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope…

Up to 1 business day

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Urine culture for microflora and determination of sensitivity to an extended spectrum of antimicrobial drugs (Urine Culture, Routine, quantitative. Aerobic Bacteria Identification. Antibiotic Susceptibility, enlarged testing)

Synonyms: Urine Culture, Routine, quantitative. Aerobic Bacteria Identification. Antibiotic Susceptibility Enlarged Testing.
Brief description of the study “Urine culture for microflora and determination of sensitivity …

Up to 6 business days

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2 300 RUB

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Gram Stain. Bacterioscopic examination of different smears

Synonyms: Analysis of a Gram stain.

Microscopic (bacterioscopic) examination of Gram-stained smear.

Brief description of the study Microscopic examination of a smear stained …

Up to 3 working days

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RUB 685

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Comprehensive ultrasound examination of the urinary system (kidneys, ureters, bladder)

Comprehensive ultrasound scan of the urinary system, which allows to detect pathology at an early stage of development.

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Ultrasound of the bladder, determination of the volume of residual urine

Examination of the bladder to assess its structure and functional features.

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CT urinary tract

Method for assessing the state of the urinary system using computed tomography.

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For men with complaints of pain during intercourse, the doctor prescribes a study to determine the DNA of Chlamydia trachomatis in prostate secretion, ejaculate by polymerase chain reaction (PCR) with real-time detection in order to exclude urogenital chlamydia.

Chlamydia, DNA determination (Chlamydia trachomatis, DNA) in prostate secretion, ejaculate

Determination of Chlamydia trachomatis DNA in prostate secretion, ejaculate by polymerase chain reaction (PCR) with real-time detection.

Chlamydia (…

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455 RUB

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Diagnosis of prostatitis is carried out by examining the middle portion of urine in order to detect an increased content of leukocytes and pathogenic microorganisms. In addition, the level of prostate-specific antigen in the blood serum increases in a patient with prostatitis.

General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope…

Up to 1 business day

Available with home visit

410 RUB

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PSA total (Prostate-specific antigen total, PSA total)

Total PSA is a protein specific to prostate tissue used as a tumor marker. Physiological excretory product of the prostate …

Up to 1 business day

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790 RUB

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Treatment of conditions characterized by pain during intercourse

Organic dyspareunia requires treatment of the underlying gynecological or urological disease. If it is carried out correctly and in a timely manner, then the pain during intercourse disappears as it heals. However, organic pathologies often exist in parallel with psychological disorders – in these cases, as in psychosomatic dyspareunia, the psychotherapeutic help of a sex therapist is needed.

An indication for sexological correction is the fear of sexual intercourse even after the elimination of the main organic cause of pain, decreased libido, and lack of orgasm.

What to do about pain during intercourse

Patients with dyspareunia are advised by doctors not to accumulate “pain” experience, which ultimately leads to irreversible organic and psychological changes.

Sources:

1. Yarotskaya E.L. Pelvic pain in gynecology: modern approaches to the examination, treatment and rehabilitation of patients // Obstetrics and gynecology: Clinical recommendations. – No. 2, 2016. – 2. – P. 82–94.
2. Clinical guidelines “Cystitis in women”. Developed by: Russian Society of Urology. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes over time, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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