Painful sexual intercourse, called dyspareunia in medical terminology (pronounced "dis-pair-une-ee-ah"), is a common
complaint among women seeking gynecologic care. Many women report occasional pain with intercourse, but some women
have pain with every episode of sexual relations. Although it may take a few visits to a gynecologist or other
health care provider experienced in women's health, the cause of dyspareunia can usually be identified and treated.
There are three main types of painful intercourse. Perhaps the least
common is pain that occurs only after intercourse or orgasm. This can be due to uterine contractions from orgasm.
Women with this problem may get relief by taking medications like ibuprofen before intercourse, which can block
pain from uterine contractions. Another source of this type of pain is an allergy to semen, which is actually quite
uncommon. After her partner ejaculates there can be an intense burning sensation and redness around the vagina
and vulva (the outer "lips" of the vagina). There have actually been a few reported cases of women going
into shock after sexual intercourse due to an allergy to semen. A third cause of pain after intercourse is a vaginal
infection, such as a yeast infection, which can cause a burning sensation within the vagina due to irritation.
Pain immediately upon penetration or touching the outer lips of the vagina
can be caused by a variety of medical problems. For example, herpes infections cause blisters which are very tender
to the touch. A scrape or small cut at the entrance to the vagina can create pain. Some women have a hymen that
does not completely resolve after their first few attempts at intercourse, which can cause an intensely painful
sensation upon penetration. Some infections, such as yeast infections or bacterial vaginosis, create irritation
of the vulvar or vaginal tissue, leading to immediate pain with sex. And, dermatological conditions such as squamous
hyperplasia or lichen sclerosus may cause damage to the vulvar skin, making it tender to the touch. Inadequate
lubrication may also cause pain. The diagnosis of these conditions requires a thorough gynecologic exam, and, in
a few cases, a small biopsy of the skin using local anesthesia in the office. Another problem that can cause entry
pain is vaginismus, where the vaginal muscles contract involuntarily, making penetration extremely painful or impossible.
This may be due to a subconscious response to prior pain, where the body tries to protect itself from pain by "closing
off" the vagina, or may be due to psychological pain, in women who have an abuse history or who are fearful
of sexual activity. As with any condition with a potential psychological component, there is controversy about
this disorder. I have found it uncommon in my practice, but it must be considered in the differential diagnosis
of conditions that can cause painful intercourse. Treatment for these conditions is antibiotics for infection,
steroid creams for the dermatological problems, a vaginal dilator or minor surgery for a partially intact hymen,
and counseling and vaginal dilators for vaginismus. Lack of lubrication can be treated with water-based lubricants
(NOT Vaseline, which may be harmful to vaginal tissues).
Probably the most common type of pain with intercourse is "deep
thrust" dyspareunia, where deep penile penetration causes pain. This is common during passionate sexual relations,
and can come and go depending on the position used during intercourse. Many conditions can cause this type of pain,
including 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 (called adhesions), an ovarian cyst (although this is an uncommon cause of such pain),
large uterine fibroids (non-cancerous tumors of the uterus), and endometriosis, a condition where tiny implants
of blood from the uterus stick to the female organs and cause pain. Many women suffer from irritable bowel syndrome,
and intercourse can cause the uterus to hit the intestines, causing pain. Medical studies have shown that many
women with this condition are reluctant to engage in sexual relations due to fear of pain or accidental release
of gas or feces during intercourse. Some of these causes of deep-thrust dyspareunia are difficult to diagnose,
and may require multiple exams and even outpatient laparoscopic surgery. Laparoscopy, sometimes called "belly
button surgery" is an outpatient surgery where a lighted tube is inserted into the belly button to directly
view the internal pelvic (female) organs to diagnose and treat problems. Treatment of these conditions may require
various medications or even surgery, and requires the input of a health care professional experienced with these
types of problems.
In summary, a number of conditions can cause painful intercourse. Contrary
to popular belief, psychological causes are very unusual, and medical causes are usually the culprit. Therefore,
women experiencing painful intercourse on a regular basis should seek the care of a gynecologist or other women's
health care provider with experience in painful intercourse. With a little detective work and cooperation between
the patient and her doctor, treatment can be provided that will lead to a more healthy and enjoyable sex life.