Not much fun is it?
Are you experiencing pain during intercourse? If so, then the odds are that you're a woman - though at the end of this feature, you'll find advice for the small number of men who get intercourse pain.

It's not much fun having pain during sex, is it? After all, sexual intercourse is meant to be great fun, and a really happy experience. And if you get pain, then it isn't.

Fortunately, the trouble will often resolve if the man takes more time and trouble with love play, and if the couple use a sex lubricant.

Don't put up with it
You can safely disregard just one isolated episode of intercourse pain. After all, it's very easy to feel pain when a sensitive part of you is being prodded quite hard.

But if the pain keeps on happening, then please don't put up with it! Get something done to improve things.

How? If you know that your GP is skilled at dealing with these matters, then he or she would be a good person to consult.

But we have to admit that some family doctors are not brilliant at dealing with intercourse pain. So it may be more realistic to go to your local Family Planning Clinic. Many Family Planning Clinic doctors (usually women) have spent a long time being trained to deal with this type of pain.

The emotional factor
In a minute, we'll look at the possible cause of intercourse pain (or 'dyspareunia', to give it its medical name).

But it's important for you to realise that there is almost inevitably an emotional element in this problem.

You see, if you are experiencing dyspareunia, it's almost certain to be distressing for you. That distress may well make you tighten up 'down below'. And that tightening up will very likely make the pain worse next time.

Unfortunately, painful intercourse can often have a destructive emotional effect on a relationship. Sometimes couples split up because of it. So that's a clear reason why you should get the problem sorted out as soon as possible.

What causes it?
There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious. But a few are. So again, you need to get yourself assessed soon.

Vaginismus
We've mentioned the condition called 'vaginismus' first, because it's so very common.

It's a spasm of the vaginal muscles, caused mainly by fear of being hurt.

This spasm is often so painful that intercourse is impossible - sometimes for years. Frequently, a vaginismus sufferer reports that she has never had full sex in her life because of it.

It is very typical of this condition that victims have also never been able to use tampons. They tend to be very fearful of vaginal examinations, and so may never have had a smear test.

Vaginismus arouses strong emotions, and patients who have it are often very angry with partners, with doctors - and with themselves. But the condition is no one's fault.

Common causes include:

a restrictive upbringing, in which the woman was brought up to view sex as nasty or dirty or wicked.

an upbringing in which the woman was somehow given the idea that the vagina is very narrow, and that sex must be very painful.

a background where rape or childhood sexual abuse has taken place. Experiences like these understandably make women fearful of sex, and of being hurt.

painful vaginal infections.

unease with the partner - perhaps at an unconscious level.

It is a common misconception that women with vaginismus dislike sex. In fact, many women with this condition enjoy closeness with their partners. Loads of them get great pleasure from love play - and indeed some are able to reach orgasm in this way. However, the enjoyment ceases when penetration is attempted or suggested.

In the UK, women doctors who have been trained by the Institute of Psycho-Sexual Medicine have by far the greatest experience of treating vaginismus. Some of them work privately, but many of them work in Family Planning Clinics, where the treatment is free.

Is the pain deep inside - or is it superficial?
One of the first things to establish is this. Is the pain deep inside you?

Or is it near the outside?

That may not be easy for you to say. And sometimes a pain is both superficial and deep.

But deciding whether it's deep inside (or just near the outside) can help sort out what's wrong.

What are the causes of deep pain?
These include vaginismus (see the section above) and a number of other causes.

Problems with your cervix. The man's penis hits the cervix at maximum penetration. So infections of the cervix and 'raw' places on it can cause pain during deep penetration.

Womb trouble. Various womb disorders, including fibroids, can cause deep intercourse pain.

Endometriosis. This very common disorder often affects the womb and surrounding tissues. The 'poking' of a penis on a tender area of endometriosis may cause intense, deep pain.

Ovary problems. Cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.

Pelvic inflammatory disease. This is caused by infection, and is becoming more common in the UK - largely thanks to the 'bug' called chlamydia. The tissues deep inside become badly inflamed, and the pressure of intercourse causes deep pain.

Ectopic pregnancy. This means a pregnancy outside the womb - usually in the Fallopian tube. Pressure on it can be very painful.

What about more superficial pain?
Pain that is nearer the outside of the vagina can also be caused by vaginismus (see above). However, there can be many other possible causes.

Lack of lubrication This can be due to nervousness, hang-ups and failure to relax. Unskilled 'foreplay' by the man is a common cause - especially when the foreplay doesn't go on long enough. (Many women would like half an hour - but don't get it!)

Menopausal or post-menopausal dryness
This is usually due to a fall in female sex hormones. Treatment with HRT pills or (more directly) hormone cream will usually put matters right. And ordinary sex lubricants will help too.

Vaginal infections
These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas.

Injury
Sadly, injury to the vulva or vagina can occur during rape or sexual assault - and later cause dyspareunia. Much more commonly, injury is caused by a childbirth tear - or the cut (episiotomy) that is so often made during labour. (Badly healed stitching can often cause pain.)

Genital warts
These are awfully common in these days of fairly promiscuous sex. Sometimes the warts can cause pain.

Vulvitis
This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps.

Haematoma of the clitoris
I first encountered this about 30 years ago, but it's still not widely known. It's a bruise (or collection of blood) in the clitoris, caused by excessive friction.

Urethral caruncle
This is a tender patch that develops at the urinary opening.

Foreign body in the vagina
The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon causes an infection.

Cancer
A rare cause of intercourse pain. But it must be borne in mind in a woman who develops this kind of pain for the first time after the age of 40.

Does intercourse pain affect men?
Yes, males do sometimes experience pain during intercourse. Common causes are disorders of the skin of the penis, such as eczema or psoriasis. Or it can be that the woman's vagina is too tight for her partner. A good sex lubricant can help here!

Occasional causes of male pain include:

a forgotten stitch left in the woman's vagina after childbirth.

an IUD thread - or a displaced IUD.

Peyronie's disease - a male disorder that causes bending of the penis.

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