Description

Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many people have painful intercourse at some point in their lives.

The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh). It is long-lasting or recurrent genital pain that occurs just before, during, or after sex. Talk with your health care professional if you're having painful intercourse. The treatments focus on the cause and can help stop or lessen this common problem.

Symptoms

If you have pain in the sexual relations, you may feel:

  • The pain only sexual input, called the penetration.
  • Pain with each penetration, including putting in a tampon.
  • Deep pain during the push.
  • Pain, burning or pain.
  • Throbbing pain that lasts for hours after sexual intercourse.

When to see a doctor

If you have recurrent pain during sex, talk with your health care professional. The treatment of the problem can help your sex life, your emotional intimacy and your self-image.

Causes

The physical causes of painful intercourse will vary, depending on whether the pain occurs at entry or with deep penetration. Emotional factors may be associated with many types of painful intercourse.

Entry of pain

Pain during penetration might be associated with a variety of factors, including:

  • There is not enough lubrication.This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breastfeeding can also be a cause. Certain medications can affect sexual desire or excitement. That can decrease lubrication and make sex painful. The medications include antidepressants, blood pressure medications, sedatives, antihistamines and certain birth control pills.
  • Injury, trauma or irritation. This includes injury or irritation of an accident, pelvic surgery, female circumcision or a cut made during childbirth to widen the birth canal, the so-called episiotomy.
  • Inflammation, infection, or disorders of the skin. An infection in the genital area or urinary tract can cause pain during intercourse. Eczema or other skin problems in the genital area can also be the cause.
  • The vaginismus. These involuntary spasms of the muscles of the vaginal wall, you can make penetration painful.
  • A problem present at birth. Not having a full training of the vagina, called agenesis, vaginal, or have a membrane that blocks the opening of the vagina, it is called imperforate hymen, it may cause pain during intercourse.

There is not enough lubrication. This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breastfeeding can also be a cause.

Certain medications can affect sexual desire or excitement. That can decrease lubrication and make sex painful. The medications include antidepressants, blood pressure medications, sedatives, antihistamines and certain birth control pills.

Deep pain

Deep pain usually occurs with deep penetration. It could be worse in certain positions. The causes are:

  • Certain diseases and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor conditions, adenomyosis, hemorrhoids and ovarian cysts.
  • Surgeries or medical treatments. The scars of the pelvic surgery, including hysterectomy, can cause pain during intercourse. Medical treatments for cancer, such as radiotherapy and chemotherapy, can cause changes that make sex painful.

Emotional factors

Emotions are deeply intertwined with the sexual activity, which might play a role in sexual pain. Emotional factors include:

  • Psychological problems. Anxiety, depression, concerns about physical appearance, fear of intimacy or relationship problems can contribute to a low level of excitation, and the resulting pain or discomfort.
  • Stress. The pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
  • History of sexual abuse. Not everyone with dyspareunia have a history of sexual abuse. But if you have been abused, may play a role.

It can be difficult to determine if the emotional factors are associated with dyspareunia. The initial pain can lead to fear of recurring pain, it is difficult to relax, which can lead to more pain. You can begin to avoid sexual intercourse if it is associated with the pain.

Risk factors

Many factors can increase the risk of pain in sex. These include diseases, surgeries and other medical treatment, and mental health problems.

Diagnosis

A medical evaluation for dyspareunia usually consists of:

  • A medical history completa.Su health professional could ask when the pain started, where it hurts, how it feels and if that happens with each sexual partner, and every sexual position. Your health care professional may also ask you about your sexual history, and surgical history of the history of childbirth. Don't let embarrassment stop responding with sincerity. These questions provide clues as to the cause of your pain.
  • A pelvic examination.During a pelvic exam, your health care professional can check for the symptoms of irritation of the skin, infection or anatomical problems. Your health care professional may also be trying to locate the pain through the application of gentle pressure on your genitals and the muscles of the pelvis. A visual examination of the vagina may also be part of the evaluation. For this test, an instrument called a speculum is used to separate the vaginal walls. Some people who have pain in the sexual relations also have pain during a pelvic exam. You may request to stop the test if it is too painful.
  • Other tests. If your healthcare provider suspects of certain causes of pain in sexual intercourse, you might have a pelvic ultrasound.

A complete medical history. Your health care professional may ask you when the pain started, where it hurts, how it feels and if that happens with each sexual partner, and every sexual position. Your health care professional may also ask you about your sexual history, and surgical history of the history of childbirth.

Don't let embarrassment stop responding with sincerity. These questions provide clues as to the cause of your pain.

A pelvic examination. During a pelvic exam, your health care professional can check for the symptoms of irritation of the skin, infection or anatomical problems. Your health care professional may also be trying to locate the pain through the application of gentle pressure on your genitals and the muscles of the pelvis.

A visual examination of the vagina may also be part of the evaluation. For this test, an instrument called a speculum is used to separate the vaginal walls. Some people who have pain in the sexual relations also have pain during a pelvic exam. You may request to stop the test if it is too painful.

Treatment

Treatment options vary depending on the cause of the pain.

Drugs

If an infection or a medical condition that contributes to their pain, the treatment of the cause may resolve your problem. Change the medications that can cause lubrication problems can also eliminate the symptoms.

For many postmenopausal women, pain at the sexual intercourse is caused by too little lubrication resulting from low levels of estrogen. Often, low levels of estrogen can be treated with topical estrogen is applied directly to the vagina.

The Food and Drug Administration approved the medication ospemifene (Osphena) for the treatment of moderate-to-severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen in the vaginal lining.

The disadvantages are that the medication can cause hot flashes. It also entails the risk of stroke, blood clots and cancer of the lining of the uterus, called the endometrium.

Another medication to relieve the pain in sex is prasterone (Intrarosa). It is a capsule that is placed inside the vagina on a daily basis.

Other treatments

Some therapies that do not involve the drug could also help with painful intercourse:

  • Desensitization therapy. For this therapy, you learn to vaginal relaxation exercises that can relieve the pain.
  • Counseling or sex therapy.If the sex has been painful for some time, you might have a negative effect on the emotional response to sexual stimulation, even after treatment. If you and your partner have avoided the intimacy due to painful sexual intercourse, you also may need help to improve communication with your partner, and the restoration of sexual intimacy. Talk to a counselor or sex therapist can help solve these problems. The cognitive-behavioral therapy can also be useful in changing the negative patterns of thought and behaviors.

Counseling or sex therapy. If the sex has been painful for some time, you might have a negative effect on the emotional response to sexual stimulation, even after treatment. If you and your partner have avoided the intimacy due to painful sexual intercourse, you also may need help to improve communication with your partner, and the restoration of sexual intimacy. Talk to a counselor or sex therapist can help solve these problems.

The cognitive-behavioral therapy can also be useful in changing the negative patterns of thought and behaviors.

Lifestyle and home remedies

To help with the pain during sex, you and your partner may want to try:

  • Change of positions. If you have severe pain during the push, try different positions, such as being over the top. In this position, you may be able to regulate the penetration depth that feels good to you.
  • Communicate. Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
  • Don't rush. More foreplay, you can help stimulate your natural lubrication. You can reduce the pain by delaying the penetration until you feel fully awake.
  • The use of lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one that you like.

Coping and support

Until the vaginal penetration becomes less painful, you and your partner may find other ways to be intimate. Sensual massage, kissing and mutual masturbation, offer alternatives to sexual intercourse, which may be more comfortable, more satisfying and more fun than your regular routine.

Preparing for your appointment

Talking with your health care professional is the first step in the resolution of pain during the intercourse. Your primary health care professional can diagnose and treat the problem or refer you to a specialist.

What you can do

To prepare for the conversation with your health care professional, to make a list of:

  • Their sexual problems, including when they started and how often, and under what conditions they occur.
  • Your key medical information, including conditions for which it is being treated.
  • All the medications, vitamins, or other supplements you are taking, including dosage.
  • Questions to ask your health care professional.

Some questions are:

  • What could be the cause of my problem?
  • What lifestyle changes can I do to improve my situation?
  • What treatments are available?
  • What books or other reading materials can recommend? What sites do you recommend?

What to expect from your doctor

Your health care professional may ask you questions such as:

  • How long have you had painful sexual intercourse?
  • Where do you feel the pain?
  • Does the pain occurs every time you have sex, or just in certain situations?
  • How is your relationship with your partner?
  • They are able to discuss their sexual problems with your partner?
  • Do any asexual activities that cause pain?
  • How much anxiety do you feel about your sexual problems?
  • Do you have vaginal irritation, itching, or burning?
  • Have you ever been diagnosed with a gynecological condition or had gynecologic surgery?
Symptoms and treatment of Painful sexual intercourse (dyspareunia)