Painful intercourse (dyspareunia)
Do you get pain during intercourse? If so, then the odds are that you're a woman – though at the end of this article, you'll find advice for the small number of men who get intercourse pain.
It's not much fun having pain during sex. After all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.
Fortunately, the trouble will often resolve if the man takes more time with love play so the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like Eros or Liquid Silk.
When to seek help
You can safely disregard one isolated episode of pain during sex. It's easy to feel pain when a sensitive part of you is being prodded quite hard.
But if the pain keeps on happening, you shouldn't feel you have to 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 most family doctors are not trained in dealing with pain during intercourse.
It might 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 by the Institute of Psychosexual Medicine (IPM) to deal with this type of pain.
Unfortunately, family planning clinics have become rather swamped with patients needing help, and they don't have as much time as they used to for helping women with intercourse difficulties.
An alternative is to see a female IPM-trained doctor privately. There are also excellent NHS psychosexual clinics in some parts of the country - notably Sheffield, Preston, Paddington and Tooting.
A very good low-cost sexual counselling service is provided by both Relate and Relate Scotland.
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 to realise that there is usually some emotional element in this problem.
If you experience pain during sex, it's almost certain to be distressing for you. This distress may well make you tighten up down below. And this 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.
Ideally, the assessment should be done by a doctor who is skilled in the technique of vaginal examination.
One of the first things to establish is: is the pain deep inside you? Or is it near the outside?
This spasm is often so painful that intercourse is impossible - sometimes for years.
Some women with vaginismus have never been able to have full sex or even use tampons. They also tend to be very fearful of vaginal examinations and so may never have had a smear test.
Vaginismus arouses strong emotions, and women who have it are often very angry with partners, doctors and themselves. But the condition is no one's fault.
Common causes include:
It is a common misconception that women with vaginismus dislike sex altogether.
In fact, many women with this condition enjoy closeness with their partners.
Many get great pleasure from love play and some are able to reach orgasm in this way. But the enjoyment ceases when penetration is attempted or suggested.
In the UK, women doctors who have been trained by the Institute of Psychosexual Medicine have by far the greatest experience of treating vaginismus.
What are the other causes of deep pain during sex?
What are the other causes of more superficial pain?
Well-endowed partner
In fact, when a woman is aroused and relaxed, the vagina extends by several inches - so any female should be able to accommodate any male.
But being unused to a larger man or previous problems with bladder infections or endometriosis can lead to anxiety and tension about sex.
A recent invention may be of use here. It is a kind of cushioned ring that the man wears on the base of his penis. This reduces the length of the penis that goes into the vagina. For more details, visit www.comeclose.co.uk
Menopausal or post-menopausal dryness
Vaginal infections
Injury
Much more commonly, injury is caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.
Genital warts
Vulvitis
Haematoma of the clitoris
Urethral caruncle
Foreign body in the vagina
Vulvodynia
Its cause is not yet known, but it can often be successfully treated.
The experts in dealing with it are the doctors at genitourinary medicine (GUM) clinics.
Cancer
Does intercourse pain affect men?
Common causes are skin disorders on the penis such as eczema or psoriasis.
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:
Some women complain that their partner's penis is too big.
This is usually due to a fall in female sex hormones. Treatment with HRT pills or hormone cream will usually put matters right. Ordinary sex lubricants will help, too.
These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas. The blisters of herpes can also be really painful.
Injury to the vulva or vagina can occur during rape or sexual assault and later cause dyspareunia.
These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.
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.
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. It nearly always gets better within a few weeks.
This is a tender patch that develops at the urinary opening.
The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon leads to an infection.
A distressing and long-lasting condition in which the outside part of the sex organs (the vulva) is so sensitive, just touching the area makes the woman jump with pain.
This is a rare cause of intercourse pain, but it must be borne in mind for a woman who develops this kind of pain for the first time after the age of 40.
Sometimes men experience pain during intercourse.
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