Painful Sex

Painful sex can be a consequence of a number of different conditions, such as infections, endometriosis, menopause, Pelvic Inflammatory Disease, childbirth or injury. It can also be the result of genital surgeries, female genital anatomical structures or intersex mutilations. Many of those having a vagina 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.

About the nature of the pain:

  • When or where do you feel the pain?
  • Is it near the vaginal entrance on penetration or is it a deeper pain?
  • Do you have any other abdominal pains?
  • Do you experience more pain every time you have sex or not?
  • If not what is different?
  • Are there other symptoms?

This may indicate infection or other pathologies.

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

Foreplay and non-penetrative sexual behaviour:

  • Are you aroused and lubricated enough?
  • Do you reach orgasm?


  • Has your relationship with your partner changed in some way?
  • Do you enjoy yourself as much as your partner?
  • Are your lovers or are you more concerned about her painful sexual activity or your 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?
  • Are you trusting the method used?
  • Are you breastfeeding?
  • Are you 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 childbirth a counsellor could be roped in to help.

If there are any relationship difficulties, counselling could be suggested to encourage more communication between the couple for a better solution to the problem.

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

Vaginismus is the involuntary spasm (tightening) of the outer third of the vagina, making all types of vaginal penetration difficult or impossible at times.

This condition can be treated; however, 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.

The Women's and Men's Health physiotherapy (#link on services) service is currently based at Mater Dei Hospital offering a range of services for persons suffering from vaginismus and more.

Vulvodynia is chronic pain in the area around the opening of the vagina (vulva) for which there is no identifiable cause. The vulva is the female genital part on the opening to the vagina.

It can occur in females of all ages. Symptoms of vulvodynia include:

  • Burning, stinging, or sore
  • Felt more when sitting down
  • Triggered by touch, such as during sex or when inserting a tampon
  • Constantly in the background

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.

A combination of treatments can often help relieve the symptoms of vulvodynia and reduce its impact on your life. Counselling and partner support may also provide relief. Other methods that can be utilised are relaxation techniques, physiotherapy and medications such as local anaesthetics, topical oestrogen creams, antidepressants, anticonvulsants and nerve blocks.

Possible causes of vulvodynia may be caused by a problem with the nerves supplying the vulva. The nerve damage can be caused by:

The picture below shows possible causes of painful intercourse.