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Painful Sex in Women

A VERY COMMON PROBLEM

Painful sex is a very common problem for women and can occur at any age. Three out of four women experience painful sex at some stage in their life. For some women this may be only temporary, while for others it may be a long term problem. The medical term for painful sex is dyspareunia. (dis-par-roonia)

Sex is a normal and enjoyable part of many people’s lives and is often an integral part of a relationship. Pain during sex can cause significant emotional distress and can lead to avoidance of sex and intimacy, which in turn can affect a relationship.

TYPES AND LOCATION OF PAIN WITH SEX 

Pain with sex can occur in the vulval area (the outside), in the vestibule (the area surrounding the vagina), just inside the vagina itself, or deep within the vagina or pelvic area. Pain can be in many forms including irritation, burning, stabbing, aching, throbbing or cramping.  It can range from mild to moderate or can be severe preventing any sexual activity. Pain during sex can be one off, short lived, recurrent or long term.

CAUSES OF PAINFUL SEX 

Painful sex can have many different causes, however, sometimes a physical cause is not found.  

  • Pain in the vulval area may be caused by infections such as thrush, skin conditions such as dermatitis, or the cause may be unknown. 
  • Pain at the entrance to the vagina when penetration with a penis, finger or sex toy is attempted may be caused by infections or skin conditions; spasm of the pelvic floor muscles; the presence of damage or scarring following childbirth or surgery; lack of lubrication; lack of sexual arousal; or changes that can occur after menopause.
  • Pain on deep penetration may be caused by lack of arousal, infection, conditions related to the ovaries such as ovarian cysts; endometriosis; lower back problems; bladder or bowel problems or may simply be due to the sexual position used during deep penetration.
  • Pain can also be due to how the nerves in the genital and pelvic area respond to sensation, and how the brain interprets signals from these nerves. This can happen with no tissue damage and no specific pathology.

Emotional or psychological causes of pain are common and maybe a part of the picture or a cause themselves. 

DIAGNOSIS AND MANAGEMENT

If you experience painful sex, it is important that you see a doctor who has a special interest in this area. They will be able to help you with tests to identify possible causes, and if needed, prescribe medication, or refer to other medical specialists such as dermatologists and gynaecologists. Managing painful sex usually means receiving care from a variety of health professionals. The doctor will discuss with you the role of pelvic floor physiotherapy, psychological and counselling support, and sex and relationship therapy in managing your situation.

SELF-HELP STRATEGIES

Talk to your partner about what you like and what feels good for you with sex.

  • Try to make time for sex and create good conditions for sex. For example allow some time to unwind and relax first, make sure that you are comfortable, that the room is not too cold or hot, don’t feel rushed, and make sure that you cannot be disturbed (have a lock on the door if you have children or housemates who may interrupt you), put on some music if that feels good, and turn your phone off!
  • Empty your bladder beforehand because having a full bladder can cause discomfort during sex.
  • Use plenty of lubricant. If you are using condoms make sure it’s a water based lubricant. If you are not using condoms then a pure vegetable oil such as sweet almond oil can be an excellent lubricant as well as a vaginal moisturiser.
  • Negotiate what you want, if you just feel like some pleasurable touching then talk about that with your partner. If penetrative sex feels too difficult then negotiate something else, mutual masturbation, oral sex, or just sensual touching or massage. Intimacy does not have to involve penetration.
  • Allow yourself to focus on sexy thoughts, try not to pay attention to anxious or stressful thoughts. Focus on your body and the sensations you are feeling. Being present in the moment can be a very helpful skill in managing pain and increasing pleasure during sex. 
  • Make sure you have plenty of pleasurable touch and foreplay and feel ready for sex before attempting any penetration.

COUNSELLING SUPPORT

Emotional, psychological and relationship factors play an important part in painful sex. They can be a cause of pain in sex, or be part of the problem.

Counselling with an experienced sexual and relationship counsellor can be very valuable in improving the situation for you and your partner. 

RESOURCES AND BOOKS


PAINFUL SEX BROCHURE PDF DOWNLOAD

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Last updated Oct 2018. REFERENCES: American College of Obstetricians and Gynecologists (ACOG). Australian and New Zealand Vulvovaginal Society (ANZVS)

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