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Pain During Sex

Pain during sex can cause a lot of issues among couples. The exact causes of dyspareunia are not always clear, but it is often thought to be a result of physical or psychological factors, or a combination of the two.

Physical causes may include vaginal dryness, hormonal changes, damage to the pelvic floor muscles, or scarring from surgery or infection. Psychological causes may include anxiety, stress, relationship problems, or memories of past trauma.

Dyspareunia can be a difficult condition to deal with, but there are treatments available that can help.

What is pain during sex?

Women with dyspareunia may experience pain in the vulva (the area surrounding the opening of the vagina) or pain within the vagina. Women may also experience “deep pain” in the lower back, pelvic region, uterus or bladder. Recurring pain can affect self-esteem and relationships, dramatically altering a person’s sex life.

Some women may experience pain during intercourse temporarily or occasionally. Other women may experience chronic pain during intercourse. Unintended severe, sharp or chronic pain during intercourse is not normal.

Symptoms of dyspareunia

The type and location of pain during sex can vary greatly from woman to woman. Common symptoms that may occur prior to, during or after intercourse could include:

  • Sharp or severe pain during penetration.

  • Pain with every kind of penetration, including when using tampons.

  • Deep pain inside the vagina or pelvis during intercourse.

  • Burning, itching or aching.

A woman may experience pain during intercourse throughout her life, or she may experience pain in certain circumstances or with certain partners. Intense or chronic pain during intercourse should be assessed by a doctor.

Physical causes of pain during intercourse

Pain during penetration can be due to a number of factors including the following.

  • Dryness or insufficient lubrication.

  • Infections within the urinary tract or genitals.

  • Inflammation or skin irritation in the genital area.

  • Vaginismus, a condition where the vaginal wall spams involuntarily.

  • Genetic or structural abnormalities within the vaginal canal.

  • Inadequate healing or scarring from childbirth.

  • Scar tissue (adhesions) from existing conditions, previous infections or past surgeries.

  • Side effects from cancer treatments, such as radiation and chemotherapy.

  • Presence of endometriosis, adenomyosis, uterine fibroids, ovarian cysts, pelvic inflammatory disease or pelvic organ prolapse.

  • Vaginal dryness due to hormonal changes associated with breastfeeding.

  • Hormonal changes during menopause.

  • Medications such as some antidepressants, blood pressure medication, allergy pills or birth control pills can lead to lubrication issues, resulting in discomfort or pain during sex.

Psychological & emotional causes of pain during intercourse

The emotional well-being of a woman can play a role in her sexual health, and cause pain during intercourse. Potential emotional causes of dyspareunia include:

  • Feelings of shame, stress, guilt or fear.

  • Changes in sexual desire.

  • Anxiety or depression.

  • Concerns about physical appearance.

  • Relationship problems.

  • History of sexual abuse or trauma.

Sexual health conditions can be sparked by anxiety about sexual intimacy, infertility or body changes. Sometimes these symptoms can be associated with menopause, childbirth or cancer treatment.

When to see a doctor for painful intercourse

Some vaginal soreness is common after intercourse, but sharp or severe pain before, during or after sex is not normal. A woman should discuss her pain with her gynecologist if:

  • Sex has always been painful.

  • It has always been painful, but the pain seems to be getting more intense.

  • Sex has recently become painful, when it was not before.

  • She isn’t sure whether the pain she is experiencing is normal.

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