Sex & Pain

mail-mark-taskIt is estimated that up to 60% of women experience sexually related-related pain at some point in their life. The medical term for painful intercourse is dyspareunia.  Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse and causes personal distress.

Sexual pain may be superficial (pain around the vaginal opening) or deep inside the vaginal causing pelvic pain.

Common Presenting Complaints

  • Pain upon penetration
  • Pain with tampon insertion or Pap smear
  • Burning or “knife-like” pain
  • Paper cut tears around the vaginal opening
  • Dryness or itching around the vaginal opening
  • New development of pain after previously pain-free intercourse
  • Deep pain which may feel like “something is being bumped into”
  • Abdominal, pelvic, bladder or back pain
  • Pain that is worse following sexual activity
  • Pain after sitting for prolonged periods or wearing tight clothing

Causes Of Superficial Pain

Hormone imbalance: A lack of estrogen or testosterone can cause thinning and atrophy of the vaginal tissues. This commonly occurs with menopause, surgical removal of the ovaries, breast feeding, hormonal contraceptives, breast cancer

Injury or trauma:

  • Pelvic/gynecologic surgery
  • Scar tissue (ex., episiotomy)

Infection: Recurrent vaginal or urinary tract infections can trigger an inflammatory response and cause pain around the vaginal opening. The pain may persist even after the infection has been treated due to persistent inflammation.

Dermatologic Conditions: A vaginal skin condition such as lichen sclerosus can cause the vaginal tissues to become thin and feel like “paper cut tears.”

Inflammation or allergic reactions: Some products can irritate the vaginal tissues and trigger an inflammatory response. Once the irritant is discontinued, the pain and discomfort may persist. Examples include: scented soaps, “warming” lubricants, and over the counter treatments for a vaginal infection.

Causes Of Deep Pain

  • Endometriosis
  • Interstitial cystitis
  • Ovarian cysts
  • Radiation
  • Chemotherapy
  • Scar tissue after surgery
  • Uterine fibroids
  • Retroverted uterus

Emotional Contributors To Pain

Psychological conditions: Anxiety, depression, concerns about physical appearance, fear of intimacy, relationship problems can contribute to painful intercourse.

Stress: Pelvic floor muscles are sensitive to stress and this can contribute or lead to painful intercourse. A history of sexual abuse or rape can also contribute to pain.