Painful sex

What is painful sex?

Painful sex is persistent or recurrent pain in the genital area that occurs just before, during or after sexual intercourse.

Painful sex may occur due to physical or psychological problems.

4 out of 10 women on direct questioning will admit to this problem.

Pain may be experienced at sexual penetration, insertion of tampon, deep pain during thrusting, or a burning pain or ache, which may linger for hours after intercourse.

What are the causes of painful sex?

This may be physical or psychological in origin and may occur at penetration or deep in the pelvis

Painful penetration (superficial dyspareunia) may occur due to

Insufficient lubrication: due to low estrogen levels after the menopause, or after childbirth or breastfeeding.

Drugs: such as antidepressants, anti-hypertensives and contraceptive pills can reduce sexual desire and arousal

Trauma: Tears and episiotomy from childbirth and female circumcision can cause scarring.

Infection: Genital tract infections like Herpes

Skin conditions: Eczema and Lichen Sclerosis can cause irritation and inflammation of the skin around the vagina.

Vaginismus: Involuntary spasms of the vaginal wall muscles which makes attempt at penetration extremely uncomfortable.

Congenital abnormalities: A band of skin that occludes the vaginal opening (imperforate hymen) or the absence of a well formed vaginal (vaginal agenesis).

Deep pain (deep dyspareunia) may occur due to

Clinical conditions such as:

  • Endometriosis
  • Pelvic inflammatory disease
  • Uterine fibroids
  • Ovarian cysts
  • Chronic Cystitis
  • Irritable bowel syndrome
  • Uterine prolapse

Scarring (adhesions): from previous pelvic surgery such as caesarean section, hysterectomy and following radiotherapy

Psychological problems: Depression, anxiety and body dysmorphism (issues with physical appearance are associated with loss of libido and painful sex.

History of sexual abuse is also associated with deep pain during sex.

Management will depend on the underlying cause for your symptoms. This will be discussed during your consultation.

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