Sexual intercourse is supposed to provide pleasure, satisfaction and fulfilment. We -particularly women- tend to expect flawless, movie-like sex, romantic, luscious or passionate, with music playing in the background! Well, in real life sex is not always that perfect: according to an American survey, about 1 out of 3 women reported pain the last time that they have had sex. What’s more, many women feel ashamed to talk about it, giving up the idea of pleasurable sex. It is not unusual for these women to avoid having intercourse, leading to couple conflicts and eventually to psychological problems…

But why so many women feel pain while making love?

Whether it happens each time or occasionally, you feel just some discomfort or unbearable pain, dyspareunia (painful intercourse) can be related to a gynecological or medical problem, to your emotions or your state of mind; occasionally your partner is to blame, or maybe both of you, let’s not forget that it takes two to tango!

Below you will find 8 common painful situations you may encounter during intercourse. Understanding the type and location of the pain will help us pinpoint its cause, so that you can take some measures to get over it!

Problem # 1: “I feel a burning sensation outside the vagina”

You may feel a painful, burning sensation in your vulva (the external genitals), the area may be red and eventually swollen.

Possible causes:

• Yeasts or other infections: a yeast infection will cause “cottage cheese-like” discharge; other bacteria can produce yellow or green discharge which may also be foul-smelling.
• Contact dermatitis: you may realize that the problem starts after using certain lubricant, soap or cream, laundry soaps or softener; certain clothes can also be responsible.
• Allergic reaction to condoms: the burning feeling starts after having sex, usually within 48 hours.
• Menopause: although menopause generally causes vaginal dryness, some women also feel intense burning, which gets worse with intercourse.

What to do about it:  

• Check with your doctor, who can give you a treatment for your yeast infection, if you are prone to get them, over-the-counter medications are available.
• In the doubt, your doctor may order a culture, to see which bacteria is responsible for your symptoms.
• In case of dermatitis or allergic reaction, stay away from possible irritants, your doctor can prescribe you a cream to soothe discomfort.
• If you are allergic to latex (the material condoms are made of), stick to non-latex condoms.

Problem # 2: “I have a painful bump in my vulva”

You may feel a sharp, localized pain; while trying to precise its location you may touch a “bump” in the vulva. If you look with a mirror you may be able to identify the spot. Sex, due to rubbing, will make it even more painful.

Possible causes:

• Pimple or ingrown hair: these are the commonest “bumps” appearing in the genitals. They can be quite sore if they become infected. A clogged sweat gland can also cause a painful pimple.
• Bartholin gland cyst: they are soft cysts arising at the opening of the vagina. They can be very large (like a walnut) and become extremely painful if they get infected.
• Herpes: genital herpes is a sexually transmitted infection. It causes itchy, burning and painful lesions that often start as a sore spot, becoming over a few days one or several blisters. Read more here.
• Other dermatological or medical problems: rarely, diseases causing genital ulcers may be the cause of pain.

What to do about it:

• Check with your doctor if you are not sure what is causing you pain.
• Pimples may require a local cream to relief pain. If they are infected antibiotics may be necessary; more rarely incision and drainage are needed.
• Bartholin cysts are treated with warm sitz baths. If infected antibiotics, incision and drainage may be necessary.
• Herpes is managed with antiviral medications (locally or by mouth), painkillers may also be required.

Problem # 3: “I’ve tried everything, but penetration is impossible and triggers excruciating pain”

You were never able to have penetration; even introducing tampons is impossible because you feel there is an “obstacle”.

Possible causes:

• Hymen problems: you hymen may be abnormally thick, or imperforate.
• Vaginal problems: your vagina can be too narrow or have a septum.
• Vaginismus: see below.

What to do about it:

If penetration was never possible, check with your doctor who can rule out any anatomical problem; most of them can be solved with a simple surgical intervention.

Problem # 4: “I have intense pain in the opening of the vagina during penetration”

Even if you are aroused and willing to have sex, penetration triggers an intense pain in the entrance of the vagina; this is called entry dyspareunia.

Possible causes:

• First time: we tend to have high expectations about our first intercourse; however many times it is less extraordinary than expected, and this includes pain; sometimes (but not always) bleeding may occur.
• Trauma: this can be the result of childbirth (a tear or an episiotomy) or surgery; occasionally injury can be sex-related.
• Vaginitis: due to yeast or other infection (see above).
• Vulvodynia: it is a distressing, long-lasting condition in which the vulva is so sensitive that just touching the area makes the woman jump with pain. When pain is confined to the vestibule (the area around the opening of the vagina), it is known as vulvar vestibulitis syndrome (VVS). Its cause is unknown.
• Emotional reasons: see below.

What to do about it:

• If it is your first time, don’t worry too much about it. Many women have pain or discomfort during their first intercourse, an even a larger percentage will not have an orgasm. Be patient, try to be as relaxed as possible, discuss with your partner the means to reduce pain. If the problem persists, discuss it with a doctor.
• If your just delivered, wait to have intercourse for at least six weeks after childbirth; some discomfort may persist for a few months, especially if you breastfeed, since your vagina also feels dry (see below). If pain continues for a long time or is very intense, talk to your doctor.
• Vulvodynia may require medications, or eventually surgery. Read more here.

Problem # 5: “My vagina feels too dry”

Vaginal dryness is extremely common, and does not always mean problem. While some women produce  a lot of vaginal secretions, others are drier. However, there are factors that influence natural lubrication levels: sexual stimulation increases the amount of secretions; therefore, adequate and prolonged foreplay will help you being aroused. Sometimes though, your vagina keeps being dry and sex becomes painful.

Possible causes:

• Menopause: due to the low level of estrogen (the hormone in charge of lubricating your genitals), your vagina will feel extremely dry and sex can be very painful, sometimes impossible.
• Breastfeeding: also related to low estrogen.
• Medications: some medications such as birth control pills, decongestants and antihistaminics may reduce vaginal moisture; contraceptive pills can also decrease sexual desire.
• Medical problems: certain medical conditions can indirectly affect sexual response: diabetes, cancer, and thyroid problems, among others.
• Your emotions: see below.

What to do about it:

• Use a lubricant. Water-soluble lubricants are the best choice if you experience vaginal irritation. Silicone- based lubricants last longer and are more slippery. Do not use petroleum jelly, baby oil, or body lotion with condoms, as they can cause the condom to break (read more here).
• For chronic cases, you may try long-acting vaginal moisturizers which, unlike lubricants, are absorbed into the vaginal lining for 3 to 4 days, mimicking natural secretions.
• For menopausal women, when lubricants or moisturizers won’t work, a vaginal estrogen product may be necessary. More info here.
• In any case, talk to your doctor if lubricants or moisturizers don’t help.

Problem # 6: “My vagina is just not opening”

Each time you try to have sexual intercourse, your vagina “closes”; any attempt of penetration is painful, and usually impossible.

Possible causes:

• Vaginismus: it is a tightening (or reflex contraction) of the muscles of your vagina which occurs during penetration, but eventually also while attempting to insert a tampon, or during a gynecological exam. Its cause is unknown, although it is frequently related to anxiety, or fear of having pain during sex. Learn more here.
• Your emotions: see below.

What to do about it:

• Progressive desensitization consists of special exercises aimed at learning to relax your vaginal muscles.
• Medical treatment may be useful in certain situations.
• For women whose vaginismus is related to fear or anxiety, psychotherapy usually helps.

Problem # 7: “I feel pain in my bladder during intercourse together with constant urge to urinate”

While having intercourse, you feel low abdominal pain and a persistent need to pee.

Possible causes:

• Cystitis: read more here.
• Interstitial cystitis (IC): also called bladder pain syndrome (BPS) is a chronic problem, which causes a feeling of pain and pressure in the bladder area, together with burning during urination. IC may feel like a bladder infection, but it’s not an infection; in fact, its cause is unknown.

What to do about it:

• Read here to see what you can do if you have a bladder infection, particularly if you get one very often.
• Regarding BPS, check with your doctor. No single treatment works for every woman, it should rather be individualized and based on symptoms. Learn more here.

Problem # 8: “I feel a deep pain in my abdomen during sex”

A deep pain or cramping in your abdomen during sex -or deep dyspareunia – can be the result of numerous problems.

Possible causes:

• Gynecological problems: endometriosis, fibroids, ovarian cyst, adhesions, or infection (pelvic inflammatory disease). Many of these also cause painful periods.
• Irritable bowel syndrome: a chronic condition that affects the large intestine; it commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. More info here.
• “Collision dyspareunia”: a funny name to describe the pain you may feel if the tip of your partner’s penis hits your cervix. This can happen if your partner is longer than average, if you’re not fully aroused, or if your cervix is unusually positioned. Read more here.
• Other reasons: constipation, a retroverted uterus, a forgotten object in the vagina (usually a tampon).

What to do about it: 

Although many of the causes of deep dyspareunia are not important, some of them can be serious; therefore, you should see a doctor, especially if it is a new-onset problem. Many of these situations will be treated with medications, others require surgical intervention.

THE EMOTIONAL FACTOR

Our emotions are tightly related to our sexual life; thus, negative emotions are frequently the source of painful sex. Some examples are:

• The way you feel about having sex: fear, embarrassment, guilt, being concerned about your physical appearance, being to too anxious about “doing it right” can all may make you unable to relax; therefore, arousal is difficult and you end up having pain.
• Stress, fatigue, anxiety, depression: your everyday life problems can affect your desire to have sex. In addition, your vaginal muscles tend to tighten; this can also contribute to painful sex.
• Relationship problems: problems with your partner may be related to painful sex by reducing arousal or provoking vaginismus.
• A previous bad sexual experience: such as women with a history of sexual abuse, who tend to relate sex with something bad or negative.

WHEN YOUR PARTNER IS THE PROBLEM…

Painful sex is not always your fault!

• Your partner may have sexual problem, which in turn can make you feel anxious about sex.
• If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, causing long and painful intercourse.
• Size problem: feel that your partner is “too big”? In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so most women should be able to accommodate most males! Nevertheless, if size is indeed a problem, try a lubricant, and check which sex positions are less likely to make you hurt. Come close, a new device can be a good option for you.

SHARED PROBLEM: SEXUAL MISMATCH

Besides size mismatch, or differences in the way you both enjoy sex, a common issue leading to painful sex is mismatched sexual desire. Read more here.

TAKE HOME MESSAGE

If you have pain during sex, talk about it! It may be embarrassing to discuss your sexual problems with a doctor, but you should know that, with proper care most problems can be solved; therefore there is no reason to condemn yourself to a pleasureless, painful sexual life!

In the meantime, these are some tips that may help you relieve your pain:

• Talk to your partner: mutual communication is essential. Discuss with your partner where and how is the pain, so you can both find ways to avoid it or minimize it.
• Use a lubricant: a simple measure that can ease your suffering. It’s a good idea to keep always one with you.
• Make time for sex: not always easy to include sex into our busy schedules! Nevertheless, try to find a moment of the day when you and your partner will be less tired or anxious.
• Engage in sexual activities that don’t cause pain: if penetration is painful, you may consider other forms of pleasure, such as oral sex.
• Try different sex positions: if you have deep dyspareunia, it can be worse in certain positions. Try to find those that are less likely to trigger pain.
• Include relaxing activities: your partner may give a massage.
• Take steps to relieve pain before making love: take a warm bath, empty your bladder, take a painkiller.
• If you experience burning after intercourse: apply a frozen gel pack or some ice wrapped in a towel to your vulva.

References

1. The American College of Obstetricians and Gynecologists: When sex is painful.
2. Lori J, Heim LTC: Evaluation and Differential Diagnosis of Dyspareunia. Am Fam Physician. 2001 Apr 15;63(8):1535-1545.
3. NHS UK: Why does sex hurt?

Photo credits

Intro: dailymedicalinfo.com; 1: rascoecam.wordpress.com; 2:liferunning.wordpress.com; 3: daroachbooks.blogspot.gr; 4: pixabay.com; 5: scienceclarified.com; 6: newauthors.wordpress.com; 7:diversehealthservices.wordpress.com; 8: everythingselectric.com; Take home: pinterest.com