Painful Sex

Painful sex can be a consequence of a number of different conditions, such as infections, endometriosis, menopause, PID, childbirth or injury. Many women find that because of a previous experience of painful sex, they anticipate that the next time they engage in sexual intercourse will be the same. This in itself can make matters worse, as this anxiety can cause the vaginal muscles to involuntary contract, making penetration even more difficult and painful.

Suggestions:

About the nature of the pain: when or where does she feel the pain? Is it near the vaginal entrance on penetration or it is a more deeper pain? Does she have any other abdominal pains? Does she experience more pain every time she has sex or not? If not what is different?

Are there other symptoms? This may indicate infection or other pathologies.

Did she have a traumatic delivery? Dish she have a tear or episiotomy? Are there other issues such as fear of penetration?

Foreplay and non-penetrative sexual behaviour: Is she aroused and lubricated enough? Does she reach orgasm?

Relationships: Has her relationship with her partner changed in some way? Does she enjoy herself as her partner? Are they lovers or is she more concerned about her painful sexual activity or her partner’s views?

Feelings about becoming a parent: Was this pregnancy planned? Is the baby still sleeping in the parents’ bedroom? Is contraception being used? Is she trusting the method used? Is she breastfeeding? Is she comfortable to do so?

 

What can be done?

An abdominal and vaginal examination should be done so as to establish the cause.

If there are any psychological causes connected to particular instance in life such as birth a counsellor could be roped in to help.

If there are any relationship difficulties, counsellor’s therapy could be suggested to encourage more talking in between the couple for better solution to the problem.

A penetration desensitisation programme can be encouraged. She is encouraged to insert one finger then two then three in her vagina while relaxing the lower vaginal muscles. This method can help both dyspareunia and vaginismus.

If a psychosexual problem persists a psychosexual therapist can to be involved together with the partner.

 

Vaginismus

This is an involuntary spasm (tightening) of the outer third of the vagina, making sexual intercourse difficult or impossible at times. Treatment depends on the cause therefore physical and medical causes should be excluded. Treatment usually combines a number of methods such as relaxation methods, physiotherapy, pelvic floor exercises and couple’s therapy in some cases.

 

Vulvodynia

Vulvodynia is chronic pain in the area around the opening of the vagina (vulva) for which there is no identifiable cause. You can experience either pain, burning or irritation. Vulvodynia can make sex uncomfortable and impossible at times. It can be spontaneously in origin or can be  triggered by touch. The condition can go on if left untreated.

It can occur in women ages 20 to 60 but usually starts in younger women. Although there is no known cause some women have found relief through counselling and partner support. Other methods that can be utilised are relaxation techniques, physiotherapy and medications such as local anesthetics, topical estrogen creams, antidepressants, anticonvulsants and nerve blocks.

The picture below shows possible causes of painful intercourse.