How to figure out why you’re experiencing pain during sex

How to figure out why you're experiencing pain during sex 1200400

The physical attraction is mutual and you have the shared desire to have sex. But what if you experience pain and discomfort when you try to? What do you do if this pain reoccurs during sex? How do you figure out what is causing the pain?

Dyspareunia is defined as “genital pain experienced just before, during, or after sexual intercourse”,1 and has been shown to be a common experience among women in the UK. A survey in the International Journal of Obstetrics and Gynaecology revealed that nearly 1 in 10 women report feelings of discomfort or pain during sex. The same survey showed that painful sex was highest in women aged 55 to 64 (10.4% of these women) and those aged 16 to 24 (9.5% of these women).2

Knowing that painful sex is relatively common is unlikely to provide much reassurance, not only because you may be feeling panic or anxiety, but also because the underlying cause can be difficult to pinpoint. To help women better understand the origins of painful sex, we’ve explored some common causes of discomfort and pain, as well as explaining what they feel like.

Superficial and deep dyspareunia

You may have heard the terms superficial and deep dyspareunia, which simply describe the region in the genital tract where the pain is being experienced during sex.

Superficial dyspareunia refers to pain coming from the external genital area, such as from the lips of the vagina (labia), the vaginal entrance (introitus), and the lower part of the vagina during the penis entry stage of sex. This typically begins with penetration or very early on after intercourse has begun, and the sensation of pain can be experienced instantly on light touch or pressure and penetration. It may continue during penetration — or make penetration very difficult — and can be described as burning or abrasive. Causes of this come from the external genitals, such as the labial and vaginal skin, or the perineal skin (the area between the vaginal opening and the back passage).

Deep dyspareunia refers to pain experienced deeper in the pelvis during or after sex. This pain may be sharp or dull, may spread down the thighs, and can last for the duration of penetration or continue for up to hours after penetration. The causes of deep dyspareunia are attributed to organs (such as the ovaries, bladder, or bowel) within the pelvis.

Causes of superficial dyspareunia

First time or relatively new to sex

Your first experience of sex can be daunting. There may be mixed emotions of desire, confusion, anxiety, and uncertainty. This may lead to difficulty in relaxing, and stimulation in the form of touching may not be something your body is used to, which can lead to difficulty in achieving an aroused state. This could mean that there is a lack of natural vaginal lubrication. Unfortunately, this vaginal dryness can make the external genital area uncomfortable during penetration.

Postmenopause and breastfeeding

The vagina can become drier during menopause or during breastfeeding, making sex uncomfortable. This is due to the drop in oestrogen levels.3 During menopause, a drop in oestrogen can cause the vaginal walls to shrink (vaginal atrophy), and the skin to thin and become more fragile.

Physical causes

There are also a range of physical causes that can bring on these types of pain.

Vaginismus is a painful powerful contraction of the vaginal wall muscles, which can make penetration and also insertion of tampons, or a finger, impossible. This can occur due to anxiety about having sex, brought on as a result of a painful past sexual experience.

Vulvodynia occurs when there is extreme sharp or burning entry pain when pressure is exerted on extremely sensitive vulval skin. Pain can also occur when you’re going about your daily life, for example if you are sitting for long periods, or wearing tight clothing, which may feel uncomfortable.

Lichen sclerosus is a painful and itchy skin condition in which white patches develop and genital skin thinning occurs. This can sometimes be mistaken for thrush.

If you have given birth and had to be cut between the vagina and the back passage (episiotomy), then often during the healing process a skin bridge forms at the back of the vagina (introitus). This may result in very sensitive nerve endings which cause pain as they are rubbed during penetration.

Bartholin’s glands, located on either side of the vaginal wall, can become inflamed (Bartholinitis) and the glands may swell during sex, which means sex may start off as painless before becoming painful during penetration.

Causes of deep dyspareunia

Intrauterine contraceptive devices such as the coil can occasionally be misplaced and can cause pain in the cervix during penetration. You can check the coil is in place by feeling for the two strings that are at the top of the vagina, though if you are in doubt about the position of your coil, see your doctor.

The cervix can also become inflamed and irritated by sexually transmitted diseases such as herpes, which can cause pain during sex, and you may notice pain is worst after sex, or there me may an offensive smell, or coloured discharge present. Sexually transmitted infections can also be present without smell or discharge, and if you are concerned you have been exposed, you should see your doctor.

Ovarian cysts (fluid filled sacs) can cause pain during deep penetration, due to the pressure on the cysts exerted by the penis, with the pain mainly being experienced during sex. Other medical conditions such as endometriosis (growth of uterine tissue in the ovaries, Fallopian tubes, and sometimes bowel walls) may contribute to pain experienced with deep penetration during sex, but also pain that continues for some time after sex.

Fibroids (benign growths in the uterus) can cause the uterus to become bulky, but these are less likely to cause pain and more likely to cause discomfort during sex.

Pelvic inflammatory disease is a condition of the uterus, ovaries, and Fallopian tubes in which infection causes the organs to become inflamed. This causes pain to worsen during deep penetration and ease slowly when penetration stops.

Other pelvic organs, which may be inflamed as a result of Crohn’s disease, ulcerative colitis, or irritable bowel syndrome, can be irritated during sex and become painful. Bowel pain can be experienced as lower tummy (abdominal) pain, or increased urge to open the bowels.  Similarly, the bladder, which can become inflamed during infection (cystitis or urinary tract infections), can also be moved and pressed on during penetration. In this case, you may experience a stronger urge to urinate after sex, or you may find you are urinating much more frequently after sex than usual. Alternatively, there may be a burning sensation when urinating, and sometimes a feeling of incomplete emptying of the bladder after sex.

Whatever the cause of your pain, it can cause distress and anxiety, and it is important to seek medical attention even if your pain is relatively mild or a minor inconvenience. Some causes of dyspareunia can be treated with the help of sex therapy or counselling. In the first instance, visit your GP or sexual health centre, where doctors will be able to refer you to the right person.

References

  1. K.R. Mitchell et al., ‘Painful sex (dyspareunia) in women: Prevalence and Associated Factors in a British Population Probability Survey’, BJOG: An International Journal of Obstetrics and Gynaecology, 2017, DOI:10.1111/1471-0528.14518.
  2. Ibid.
  3. L.J. Heim, ‘Evaluation and Differential Diagnosis of Dyspareunia’, Am Fam Physician, vol. 63, no. 8, 2001, pp. 1535-1545.

Dr. Lorna Pender MBChB BSc Hons

Lorna is a doctor by trade, and now works in the pharmaceutical industry. She enjoyed writing throughout her medical degree and she worked on numerous health-based writing projects, including medical research and writing articles for medical journals, while working as a hospital doctor for the NHS. She is excited to be able to reach a much wider audience with her writing for The Femedic and hopes readers will find greater clarity on health issues from reading her articles.

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