The most likely causes of pain during sex

Is pain during sex normal?

Many women suffer a degree of discomfort or pain during sex from time to time, but when should we seek help for our symptoms? "If you experience pain once, unless it is accompanied by other symptoms such as smelly, offensive discharge, it's probably better to wait to see if it resolves itself," explains consultant obstetrician and gynaecologist Dr Pandelis Athanasias from London Women’s Centre. "But if it happens more than three times, you should seek specialist help."

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Dyspareunia

Dyspareunia is a term used for pain felt in the genital area or pelvis during (or after having) vaginal sex. Nobody really knows exactly how common it is, as many women never seek medical help. However, questionnaires asking women if they have symptoms suggest that somewhere between 1 and 4 out of 10 women experience it. Most commonly, this is early in their sexual lives or around the menopause. There are many causes of dyspareunia, most of which are not serious or damaging in nature, but all can be detrimental to your sex life and ultimately may lead to relationship difficulties. It can be a vicious circle, with pain leading to nervousness about having sex, and nervousness leading to dryness and further pain. It's also not uncommon for dyspareunia to remain after the cause has been treated, particularly if things have been left untreated for a while. For this reason, it is important to seek help early, so that treatable causes can be discovered and managed. This leaflet discusses the types and possible causes of dyspareunia.

by Dr Hayley Willacy, FRCGP

Do lubricants help with pain during sex?

Whilst lubricants might be helpful, Anthanasias recommends women seek help rather than try to manage the problem themselves. "Sometimes continuing sexual intercourse can cause further problems," he explains. "For example, if you have a laceration or a tear, this can take some time to heal - and if the patient keeps having intercourse, it may become a more serious issue."

What causes pain during sex?

There are many different causes of painful sex, including infection, an abnormal growth such as a fibroid, an injury or even a psychological problem.

"Problems can often have multiple causes," explains Anthanasias. "Sometimes, women are sure that the problem is purely physical, but often a referral to a psychosexual counsellor can be very helpful."

"When looking at the causes of painful sex, it's helpful to separate the types of pain into superficial - affecting the vulva and the entrance of the vagina - to deep pain, which comes from the pelvis," he explains.

It's also important to tell your doctor if you've ever been able to have sex without pain. If you haven't they're likely to be looking for different causes, such as a partially intact hymen. Likewise, if the pain has started after a specific event such as childbirth, it could be due to scarring.

Causes of superficial pain during sex

Alongside infection, one of the most common causes of pain during sex is a condition known as vulvodynia. This condition causes pain in the vulval area and can be caused by a nerve problem.

"Vulvodynia can be a neuropathic condition," explains Anthanasias. "For some reason, women have more sensitive nerve endings in the vaginal area, which can cause pain." Vulvodynia may be classed as "provoked" or "unprovoked" - with some women experiencing almost constant pain, despite avoiding sexual intercourse.

Jane Barker, 32, from Hertfordshire suffered from vulvodynia whilst at university. "The first time I experienced pain after intercourse, I didn't worry too much," she explains. "However, I began to suffer lasting pain that didn’t resolve after sex. In the end I went to my GP."

"The GP examined me to check for injury, and took swabs to rule out infection. When this came back clear, she referred me to a specialist clinic at the local hospital."

There, doctors diagnosed vulvodynia, along with inflammation - and they also detected that some of Jane’s vaginal muscles had gone into spasm. However, as there isn’t a specific treatment for this condition, it continued for some time.

"The doctors tried various medicines and creams, including antidepressant medication," explains Jane. "In the end, a combination of pelvic floor exercises to help me to regain control of my vaginal muscles and an oestrogen-based cream brought relief."

Despite having had her condition treated effectively, Jane still suffers from flare-ups of the condition from time to time. "In my case, there's definitely an element that is triggered by stress," she says. "Having vaginal pain and being unable to have intercourse with your partner can be incredibly distressing, so it’s really important to have it treated."

Another cause of sexual pain and difficulty is vaginismus. "This is caused by the abnormal contraction of the pelvic muscles," explains Anthanasias. "Patients are unable to release the muscles, which can cause pain during sex or even make penetration impossible."

Finally, women who are postmenopausal may be suffering from a condition called vaginal atrophy. "This is where a lack of oestrogen causes the vaginal tissue to become very thin and dry," explains Anthanasias. "This can cause soreness, itchiness and painful intercourse."

Deep pain during sex

Rather than experiencing pain externally, many women complain of deep, pelvic pain during sexual intercourse. "The most common cause of deep pain is endometriosis," explains Anthanasias. "This is a condition where the lining of the womb is found outside the womb. It causes scarring, nodules and pain on deep penetration."

Causes of pelvic pain during intercourse are often 'mechanical' in nature. "A big ovarian cyst, for example, or a mass," explains Anthanasias. "Or another structure like a big fibroid that occupies the pelvis."

Also, although pelvic inflammatory disease often leads to other symptoms, including low abdominal pain, vaginal discharge, abnormal bleeding and fever, deep pain during sex is sometimes the main feature.

Whilst both types of pain can be equally distressing, this deep pain is "more likely to have a surgical treatment" than the more superficial, external pain.

Is pain during sex a medical emergency?

Whilst pain during sex can be distressing, it is rarely an urgent issue. "Urgent help is only required when any pain is combined with severe bleeding," explains Anthanasias.

Where to get help for painful sex

The first port of call for women suffering from painful sex is usually the GP, who will check for infection or injury and make a referral to a specialist if necessary. However, those suffering from painful sex can also visit a genitourinary medicine (GUM) clinic.

GUM clinics offer a range of services, including testing for STIs and other genital infections, often with results received on the same day.

Time to talk?

We may not enjoy talking about sexual problems, but if you're suffering from pain during sex, it's important to visit your doctor earlier rather than later. "Quite often, patients who come to me have had symptoms for months, or even years!" agrees Anthanasias.