Painful sex

What is Painful Sex?

Painful sex, also known as dyspareunia, refers to persistent or recurrent pain during or after sexual intercourse. This discomfort can occur for various reasons and can be experienced by individuals of any gender.

Impact of Painful Sex On Anatomy and Health

Painful sex can have significant impacts on both physical and mental health:

• Physical Impact:
• Genital Tissue Damage: Persistent pain can lead to inflammation, irritation, or even micro-tears in genital tissues.
• Muscular Issues: Pelvic floor muscles may become tense and tight, exacerbating pain.
• Reduced Sexual Function: Chronic pain can lead to avoidance of sexual activity, reduced arousal, and difficulty achieving orgasm.
• Mental and Emotional Impact:
• Stress and Anxiety: Anticipation of pain can lead to anxiety and stress, which can further inhibit sexual desire and performance.
• Depression: Chronic pain and sexual dysfunction can contribute to feelings of depression and low self-esteem.
• Relationship Strain: Painful sex can affect intimacy and communication within relationships, potentially leading to feelings of frustration and disconnection.

Who Does Painful Sex Affect?

Painful sex can become an issue for a woman at any age due to several causes. It is more prevalent in women ages 40 and above who have gone through menopause, but other women can experience it as well.

Causes of Painful Sex

Physical Causes

• Infections: Sexually transmitted infections (STIs) such as herpes, gonorrhoea, and chlamydia can cause pain during intercourse. Vaginal infections like yeast infections and bacterial vaginosis are also common culprits.
• Gynaecological Conditions: Conditions such as endometriosis, pelvic inflammatory disease (PID), and uterine fibroids can cause deep pain during intercourse.
• Hormonal Changes: Menopause, childbirth, and breastfeeding can cause vaginal dryness and thinning of the vaginal walls, leading to painful sex.
• Vulvodynia: Chronic pain in the vulvar area without an identifiable cause.
• Pelvic Floor Dysfunction: Tension or spasm in the pelvic floor muscles can make penetration painful.
• Interstitial Cystitis: A chronic bladder condition causing pelvic pain and discomfort.
• Structural Issues: Conditions like vaginal atrophy, adhesions, and congenital anomalies can cause pain.

Psychological Causes

• Anxiety and Depression: Mental health issues can contribute to physical pain and discomfort.
• Past Trauma: A history of sexual abuse or trauma can lead to pain during intercourse due to psychological distress.
• Relationship Issues: Poor communication, lack of trust, and emotional disconnection can manifest as physical pain during sex.

Situational Factors

• Inadequate Lubrication: Lack of arousal or insufficient lubrication can cause friction and pain.
• Certain Medications: Some medications, such as antihistamines and antidepressants, can cause vaginal dryness.
• Improper Positioning: Certain sexual positions may cause discomfort or pain depending on the individual's anatomy and flexibility.

Symptoms of Painful Sex

The symptoms of dyspareunia can vary depending on the underlying cause and can be classified based on their location and nature:

• Superficial Pain: Pain at the vaginal entrance during penetration.
• Deep Pain: Pain during deep penetration, often felt in the lower abdomen or pelvis.
• Burning Sensation: A burning feeling during or after intercourse.
• Throbbing Pain: A persistent throbbing sensation in the pelvic area after sex.
• Tightness: Feeling of tightness or spasms in the pelvic floor muscles during penetration.

How Can Painful Sex Be Prevented?

Preventing painful sex involves addressing both physical and psychological factors:

• Maintain Vaginal Health:
• Lubrication: Use water-based lubricants to reduce friction and discomfort.
• Hydration: Drink plenty of water to maintain overall body hydration, which can help with natural lubrication.
• Avoid Irritants: Stay away from douches, scented products, and harsh soaps that can irritate the vaginal area.
• Manage Medical Conditions:
• Regular Check-Ups: Routine gynaecological exams to detect and treat any underlying conditions early.
• Medication Management: Work with a healthcare provider to manage conditions like endometriosis, PID, and interstitial cystitis.
• Psychological Well-being:
• Therapy: Seek therapy for anxiety, depression, or past trauma.
• Communication: Maintain open communication with your partner about any discomfort or pain.
• Healthy Sexual Practices:
• Foreplay: Engage in sufficient foreplay to ensure arousal and lubrication.
• Comfortable Positions: Experiment with different sexual positions to find the most comfortable ones.

Diagnosis of Painful Sex

The diagnostic process generally includes:

• Medical History:
• Sexual History: Detailed questions about sexual activity, the onset of pain, duration, location, and nature of the pain.
• Gynaecological History: Information about menstrual cycles, pregnancies, childbirth, menopause, and any gynaecological conditions or surgeries.
• Medical Conditions: Inquiry about any underlying medical conditions, medications, and past infections.
• Physical Examination:
• Pelvic Exam: A thorough examination of the external and internal genitalia to check for signs of infection, inflammation, or anatomical abnormalities.
• Vaginal Cultures or Swabs: To identify any infections like bacterial vaginosis, yeast infections, or STIs.
• Pap Smear: To screen for cervical abnormalities that could contribute to pain.
• Imaging Tests:
• Ultrasound: Visualise the pelvic organs and identify conditions like fibroids, ovarian cysts, or endometriosis.
• MRI or CT Scan: In certain cases, to get a more detailed view of the pelvic anatomy.
• Laboratory Tests:
• Blood Tests: To check for hormonal imbalances or markers of infection.
• Psychological Assessment:
• Counseling or Therapy Sessions: To explore potential psychological factors such as anxiety, depression, or past trauma.

Management and Treatment of Painful Sex

The management and treatment of painful sex depend on the underlying cause. Common approaches include:

• Medical Treatment:
• Medications: Treatment for infections, hormonal therapy for menopause-related issues, and pain relievers.
• Physical Therapy: Pelvic floor physical therapy can help alleviate muscle tension and improve sexual function.
• Surgery: In some cases, surgical intervention may be necessary, especially for conditions like endometriosis.
• Counselling and Therapy:
• Psychotherapy: Addressing underlying psychological issues such as trauma or anxiety.
• Sex Therapy: Working with a sex therapist to improve sexual function and reduce pain.
• Lifestyle Modifications:
• Lubrication: Using lubricants to reduce friction and discomfort.
• Diet and Exercise: Maintaining a healthy lifestyle improves overall well-being and reduces symptoms.

What if Painful Sex is Untreated?

A woman going through menopause experiences a lot of changes in their body. This transformation, compounded with vaginal dryness and painful sex, can result in a loss of self-esteem and sexual confidence. Most women undergo these changes silently because discussing them with their partner or doctor can be hard. Hence, it is necessary to seek consultation as early as possible.

Your Next Step

You may require further investigation if you have any symptoms relating to your vaginal dryness. You should see your general practitioner and possibly get a referral to Dr Alyousif.



Dr Alyousif can offer specialised help and advice on possible diagnoses, further investigations, and suitable treatment.