Painful sex

In women

What causes painful sexual intercourse?

The medical term for painful sexual intercourse is dyspareunia and it is a common complaint — some women may feel occasional pain while others experience pain every time they have sex. Some discomfort is frequent when you first start having sex, when you start a new relationship and after having a baby. There are three main types of painful intercourse:

 

Pain on penetration or on touching the outer lips of the vagina

This can be caused by:

  • Lack of full arousal causing discomfort on attempted penetration because of lack of lubrication and lack of muscle relaxation.
  • Sexually transmitted infections e.g. herpes infections (herpes blisters can be very tender).
  • A scrape or small cut at the entrance to the vagina.
  • Yeast infections or bacterial vaginosis (which irritate the vaginal tissue).
  • Skin disorders in the vulval area.
  • Vaginismus (involuntary spasm of the muscles that surround the entrance to the vagina).
  • Insufficient lubrication — vaginal dryness is common after the menopause.

Pain on deep penile penetration

This can be caused by:

  • A prolapsed uterus (where the cervix and uterus are ‘falling out’ of the vagina due to relaxation of the tissues that hold them up within the vagina).
  • A ‘fallen bladder’ due to childbirth.
  • Scar tissue around the uterus or ovaries.
  • An ovarian cyst (although this is an uncommon cause of such pain).
  • Large uterine fibroids (non-cancerous tumours of the uterus).
  • Endometriosis (where tiny implants of blood from the uterus stick to the female organs and cause pain).

Pain after intercourse or orgasm

This can be caused by uterine contractions from orgasm, a vaginal infection or, in very rare cases, an allergy to semen.

How is painful sexual intercourse treated?

Explain your symptoms to your doctor and try to pin down the cause of the pain. You may be prescribed antibiotics for infections, steroid creams for the skin disorders or water-based lubricants (if lack of lubrication is the culprit). Oestrogen cream is very efficient for treating vaginal dryness after the menopause.

If your pain is caused by vaginismus, psychological factors may be involved and your doctor may recommend counselling. The recovery rate from vaginismus is very high.

Contrary to popular belief, painful sexual intercourse is usually caused by medical not psychological problems, it is quite common and it can be treated.

In men

What causes painful sexual intercourse?

Painful sexual intercourse (dyspareunia)is less common in men than in women. There are three main types of painful intercourse:

Pain during intercourse

This can be caused by:

  • Infections, either balanitis or a sexually transmitted infection.
  • Anatomical problems with a bowed erection (chordee) or a tight foreskin (phimosis).
  • Difficulties with arousal or lubrication in your partner.

Pain at ejaculation

This can be caused by:

  • An infection of the prostate gland or urethra.

Pain at tip of penis after intercourse

This can be caused by:

  • Thrush infection (candida).
  • Allergy to contraceptive cream or condom.

How is painful sexual intercourse treated?

Explain our symptoms to your doctor and try to pin down the cause of the pain. You may be prescribed antibiotics for infection or creams for thrush or allergic reactions. Water-based lubricants may be helpful if lack of lubrication in your partner is the problem.

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