Painful intercourse (dyspareunia)

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Menopausal or post-menopausal dryness

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.

Vaginal infections

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

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 episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.

Genital warts

These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.

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. It nearly always gets better within a few weeks.

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 leads to an infection.

Vulvodynia

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.

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

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.

Does intercourse pain affect men?

Sometimes men experience pain during intercourse.

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:

thrush – in which case the female partner will probably have thrush too

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

an IUD thread or a displaced IUD in the vagina

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

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