Understanding emotional factors that influence pain after sex

emotional factors pain after sex

From the moment we hit puberty we are surrounded by sex. Adverts, books, films, and TV shows often contain sexual references or sex scenes, and you probably had sex education at school which told you to use a condom and watch out for chlamydia.

We grow up being told that sex is always perfect and should always be enjoyable. For this reason, if you begin experiencing pain during or after sex it can be extremely upsetting, and difficult to understand.

Pain after sex can occur for a variety of reasons, and can affect both men and women, although it is more common in women. One study reported that as many as 8-22% of people suffer from painful intercourse,1 so if this is something that is affecting you, you can rest assured that you are not alone.

The pain can be experienced in the vulva (the area surrounding the opening of the vagina), or it can be on the inside of the vagina or in the lower tummy area.

Conditions which may cause pain

Three conditions which can cause pain during or after sex are vulvodynia, dyspareunia, and vaginismus. Vulvodynia is pain around the vulva often described as a burning, stinging and raw sensation, although there is no redness or skin problems visible, and the pain can occur during or outside the times of intercourse.

The causes of vulvodynia are not known, but there have been studies suggesting that oestrogen alters the sensory receptors at many sites in the nervous system, which may increase sensitivity of the nerves, causing abnormal sensation around the vulva. As a result, vulvodynia is more common at the start of the menopause.

Dyspareunia refers to painful intercourse, which may be felt on the outside of the genitalia, or deeper in the pelvis near the cervix. It is not a diagnosis, as such, but rather describes the symptom.

We grow up being told that sex is always perfect and should always be enjoyable. For this reason, if you begin experiencing pain during or after sex it can be extremely upsetting, and difficult to understand.

Dyspareunia can be caused by a large range of conditions, such as infections in the urinary tract or genitals (such as pelvic inflammatory disease), tissue injury (from previous surgery or childbirth), or even hormonal causes, such as reduced oestrogen levels causing the vagina to become drier during menopause.

Vaginismus causes painful intercourse, and is thought to be due to the muscles of the pelvic floor around the vaginal opening contracting without any voluntary control. For this reason, any vaginal penetration (for example intercourse, tampon insertion, or a gynaecological examination) is painful. This may occur with all vaginal penetration, or just on certain occasions.

With all these conditions, their cause is often unknown. It is often due to a complex interaction between underlying physical problems and emotional factors, including, for example, anxiety, phobia, disgust, and depression. How we feel and interpret pain is very much affected by our emotions and past experiences, but just how much our emotions play a part in it all is often very difficult to determine.

Emotional factors that cause vulvodynia, vaginismus, and dyspareunia

Psychological studies have shown that dyspareunia may sometimes be a symptom of an unconscious reaction to a phobia, previous major anxiety, hostility, or fear of sex.3

During penetrative intercourse, the sensations from the vagina and the surrounding areas travel along nerves to our brain. Our interpretation of these sensations is complex. It will draw on our previous experiences, our fears, and our anxieties. This then translates to our final sensation and determines whether it is going to be pain or pleasure.

The complex pathways for all this are still not fully known. So, when we are anxious, this will affect our brain’s interpretation of the sensation, which may lead us to interpret this as pain. When we interpret this as a painful stimulus, other nerves send signals to the pelvic muscles, causing them to tense up, which may lead to more pain.

During penetrative intercourse, the sensations from the vagina and the surrounding areas travel along nerves to our brain. Our interpretation of these sensations is complex. It will draw on our previous experiences, our fears, and our anxieties.

Our previous experiences also affect our interpretation of sensation and whether we feel anxious. For example, having had a previous bad gynaecological examination, which you may or may not remember, or having had a bad sexual experience, may cause anxiety. This may be because the body may be expecting that something bad will happen again, and tries to “protect itself”, by making you think that sex is painful.

Similarly, if you have depression then this may lead you to have a different interpretation of the genital sensations experienced during sex, and you may be more likely to interpret them as pain. With depression, you might also experience symptoms such as not enjoying activities and experiencing a generalised loss of interest in everything. The causes for depression and why it affects the body like this are not well understood; genetics, neurochemicals, and hormones may all play a part.

How can you tell if emotional factors are causing your pain?

It is often impossible to tell how much emotions are playing a part in causing painful intercourse, and it is also very difficult, if not impossible, to say whether or not it is solely down to emotions. Sometimes, if you feel anxious — muscles tensing up, heart beating quickly, sweating or tremors — before having sexual intercourse then it may be that anxiety is contributing to the dyspareunia, vulvodynia or vaginismus.

If you have symptoms of depression such as very low mood, lethargy, loss of appetite, or loss of enthusiasm or interest in activities, then depression may be a cause of dyspareunia. But frequently painful intercourse is a complex interaction of physical and emotional factors.

Where can you go for help?

If sex is painful, then you should go and see your GP or go to a sexual health clinic to explore things further, as there are many treatments and options for help that are available. Some people may feel embarrassed to bring this up with a doctor, but there is no need: it is a common problem, there is a lot of help available, and you are definitely not alone, or the first person to experience this.

The doctor will take a detailed history, and take simple tests such as a urine test or vaginal swabs, in order to determine whether or not your pain may have any treatable causes, such as a urine infection. If infection is found then treatment with antibiotics or antifungal medications may help the pain.

Vaginal dryness can make the nerves more sensitive to pain, so vaginal lubricants such as gels (which you can get over the counter at pharmacies) can be used during sex, and vaginal moisturisers or oestrogen creams can be used several times a week.

If an emotional cause is likely to be a contributing factor, then treatment for this may help painful intercourse. For example, antidepressants or cognitive behavioural therapy may be prescribed for depression or anxiety conditions. Being referred for counselling may help explore bad feelings about sex, relationship, or personal issues. Often, a combination of counselling and vaginal lubrication may be needed to reduce painful sex. As the cause of pain is complex, it is always worthwhile exploring your options with your GP.

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References

  1. P. Latthe et al., ‘WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity’, BMC Public Health,  vol. 6, no. 6, 2006, p. 177.
  2. A. M. Thornton, ‘Current concepts in vulvodynia with a focus on pathogenesis and pain mechanisms’, Australasian Journal of Dermatology, vol. 57, no. 4, 2016, pp. 253-263.
  3. M. Meana M and Y.M. Binik, ‘Painful coitus: a review of female dyspareunia’, J Nerv Ment Dis, vol. 182, no. 5, 1994, pp. 264-72.

Dr. Diana Chiu MBChB (Hons), MRCP, PGCERT (Med Ed), PhD

Diana received her medical degree, with honours, from the University of Manchester. She then went on to receive basic and specialist medical training within the north west of England. She carried out in-depth research in medicine and was awarded a PhD in 2016. Currently, she is finishing her medical training at a large teaching hospital, and one of her greatest interests is medical education. She is an advanced life support instructor and writes regularly for post-graduate examination websites, and also holds a PGCERT in medical education with distinction.

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