Painful sex is a very real problem that can rock the steadiest relationship – but by finding out the possible causes, the problem can often be overcome.
Almost every woman experiences at least one episode of pain on intercourse at some time in her life – it is a simple signal that something, somewhere is not quite right.
The pain or discomfort felt may have an anatomical cause, be a symptom of infections or disease and/or be psychological in origin.
Medical textbooks tend to divide the reasons for painful sex into emotional and physical causes, but such distinct demarcation is often misleading – the two are often closely related.
Many women who experience painful or difficult intercourse are put off even trying to have sex and some even go off orgasms too. Even quite a mild degree of pain can cause anxiety. This in turn reduces the ability to become aroused and the resulting of lubrication causes even more pain.
Surface pain
It is not uncommon for first-time sex to be accompanied by a certain degree of surface pain. This is particularly likely if the girl has never inserted her fingers or a tampon into her vagina and the hymen has remained intact.
At the point of penetration for the first time, the muscles of a woman’s vagina may automatically go into spasm, partly in anticipation of pain and partly because of the anxiety of new experience. Early sex may also be uncomfortable because of a lack of lubrication.
In non-virgins, such surface pain during intercourse usually comes about as a result of an episiotomy (the incision made between the vagina and the anus during childbirth to aid delivery). Even well-repaired episiotomies can be painful for weeks after giving birth, but less expertly repaired ones can go on being painful for longer.
If a woman has a painful episiotomy scar she should complain to her doctor who can examine her to see if the repair was properly carried out. If it was not – the stitches may be too tight – then the doctor will suggest various methods of stretching the area. In some cases, he or she may recommend that the episiotomy is re-done.
Painful irritations
The commonest cause of pain inside the vagina is infection. Various infections can be present even without an obvious discharge.
For women of reproductive years, the most common infections are thrush and trichomoniasis. Thrush is characterized by a curdy, white, thick discharge – it can produce such intense itching that it is very distressing and can make even the thought of sex a nightmare. Trichomoniasis produces an irritating discharge of a yellowish green, bubbly fluid. With both infections the vulva becomes swollen and inflamed and sex is painful.
Both these types of vaginal infection should be properly diagnosed and treated by a doctor. It is also advisable to treat the woman’s partner or the couple can shuttle the infection back and forth between them for weeks or even months.
Other vaginal irritations, which may result in painful sex, can be caused by certain rubbers in contraceptives, foams, jellies and soaps and vaginal deodorants.
Deep pain
Deep pain in intercourse can be caused by a retroverted uterus (one which is tilted backwards instead of forwards). If this is the case, the pain is present from the first time a woman has sex. If the pain comes on later, after pain-free intercourse, a pelvic disorder may be the cause, such as pelvic inflammatory disease, endometriosis (when pieces of womb lining come adrift) or fibroids.
Often a doctor can decide fairly easily which is to blame, but sometimes the diagnosis can be difficult to make and he or she will have to recommend a laparoscopy (in which a thin telescopic tube is inserted into the abdomen) so that the pelvic area can be viewed directly. Women with endometriosis usually have other troublesome symptoms such as painful periods and mid-cycle pain.
If a woman’s uterus is retroverted, the ovaries are slightly altered in position and can be more easily knocked by the penis or a man’s finger during lovemaking.
Retroversion itself, however, is not a disease. It is a variation of normality and often nothing needs to be done about it. The best thing is to experiment with different intercourse positions to find those which allow the woman to remain pain free.
Sex and the menopause
In older women, after the menopause, there is a narrowing of the vagina as the lining thins under the influence of falling levels of oestrogen.
The painful intercourse that might result can be prevented (and treated) by increasing the amount of intercourse a woman has. This keeps the vagina supple and helps lubrication to return towards pre-menopausal levels. This alone can be enough to prevent painful sex.
The cycle can be broken initially by using plenty of KY or a similar lubricating jelly. If this does not improve matter, oestrogen creams work well for most women – and it is also possible, with a little creativity, to find intercourse positions that do not cause the pain.
Vaginismus
Mild attacks of difficult intercourse caused by muscle spasms (vaginismus) are common in early attempts at intercourse – and mild or transient attacks are not uncommon in women who have had perfectly normal, pain-free sex for years.
Vaginismus is the name given to the painful spasm of the vagina and pelvic floor muscles that occur in anticipation of penetration. It can occur either spontaneously or as a result of one of the physical causes of painful sex.
The causes of vaginismus are many and are often far from obvious. For the majority of young women who suffer, there is no serious underlying cause – they may be simply apprehensive or guilty, poorly aroused or sexually inexperienced.
But there are also many more deeply hidden causes. Research has shown that these can include a fear of pregnancy, a woman’s unconscious perception of her lover as her father, latent lesbian tendencies, a fear of loss of control, a belief that the vagina is too small to take so apparently large an object as a penis, negative sexual conditioning in childhood, falling out of love with a partner, an extra-marital affair, or even just a partner who puts the woman off for some reason.
Obviously, deep-rooted psychosexual causes of vaginismus need to be sorted out by trained counsellors. And any physical condition that causes pain should be treated by a doctor.
Self-help for vaginismus
Very commonly, there is no obvious medical cause, yet the woman continues to experience pain or difficulty in intercourse, which may cause her to hold back from lovemaking. With the help of a loving partner, however, and by following this programme, she may soon by able to enjoy a fulfilling sex life.
Discuss the problem together, The woman should try to understand her personal background, her early sexual experiences and her first factual information about intercourse.
The next step is for the woman to learn about her vagina. She may have picked up worrying myths as she grew up.
If a woman cannot accept the help of her partner, or he will not help, she can now slowly and gently start to insert one fingertip and then eventually a whole finger into her vagina. When she can do this easily, without pain, she can go on to a vibrator or small dildo, gradually becoming more confident until she can contemplate intercourse.
Ideally, she could engage her partner in the learning process. Then, when she is highly aroused, and, if necessary, lubricated with KY jelly, he can persuade her to open her legs wide. He slowly inserts the tip of one finger. If and when her vaginal muscles go into spasm, he stops and keeps his finger still. The woman then contracts her pelvic muscles hard around the finger – and then relaxes. Her partner then advances his finger a little further. The cycle is repeated until a whole finger can be tolerated without anxiety.
Once this stage is achieved, progress can be very rapid. But intercourse should not be attempted until the woman feels totally happy.