Even though sex is not a taboo among friends or in public anymore, there are certain sexual topics that significantly affect quality of life, yet no one is willing to talk about them. The emphasis is mainly on sexual liberation and constant exposure to sex through television, music videos, films and series, while education, the most important aspect for young people, comes last. A person’s sexual life can include things that may not be very pleasant – these are ignored and hidden behind explicit scenes and nudity. We’re talking about sexual dysfunctions, both male and female. Male dysfunctions such as erection problems, premature ejaculation and impotence are relatively frequent topics, while women’s problems are mostly neglected and not sufficiently researched. This often becomes a cause of frustration developing from not being able to physically pleasure their partners when it comes to both qualitative and quantitative sexual needs.
One of the female sexual dysfunctions is painful intercourse or dyspareunia. This problem manifests through pain that a woman feels during penetration – pain that can go from mildly uncomfortable to very strong. Pain during intercourse affects women of all ages and it sends a strong message that shouldn’t be ignored, but rather examined to find the cause and solve the problem.
Dyspareunia can be caused by physical and psychological factors. In order to find the root of the problem, a woman needs to visit a gynaecologist in order to confirm or remove a possibility for a physical cause.
Physical causes of dyspareunia
These can include inflammation of reproductive and urinary tract and vaginal mucous membranes damage caused by contraceptives (condom, diaphragm, spermicides, spiral, etc.). Women in peri- and postmenopause have reduced hormone levels causing vulvar and vaginal atrophy, as well as dryness that can severely reduce quality of sex life.
Roughness and/or disinterest of the male partner often leads to a lack of foreplay and not enough stimulation, which results in reduced vaginal secretion and uncomfortable penetration. Psychological causes can often be solved through open and honest communication with your partner that can help both of you handle the difficulties between the sheets.
Discovering the issues
As with any other health problems, it is important to find out the type and intensity of the pain so that your doctor has a guideline that can help them diagnose the issue correctly.
If you are experiencing dull pain on one side during your period that becomes sharp and piercing during penetration, in 30% of the cases it is a follicular or water cyst that is diagnosed with an ultrasound. These kind of cysts are not a cause for concern and they usually disappear on their own within two to three months. If this diagnosis is confirmed, you can continue having sexual intercourse, as long as you take a pill or a suppository with ibuprofen an hour before. It is recommended that the woman stays on top during intercourse so that she has better control of penetration.
If pain during and after intercourse is accompanied by itchiness, irritation and redness of vaginal and vulvar area with a strong burning sensation, this could mean a fungal infection. Cheese-like discharge can also appear. Fungal infection is also referred to as candidiasis or simply candida. Since Candida is almost always present in the vagina in small concentration, vaginal candidiasis doesn’t have to be caused by an outside factor. In most cases it is caused by the reduced defence mechanisms in the vaginal mucous membranes, which cannot efficiently regulate fungal colonies. This is an often occurrence after using antibiotics. That is why it is very important to support vaginal flora while using antibiotic therapy, in order to prevent candida infection.
If a fungal infection does develop, both partners need to start with appropriate therapy while abstaining from sex as long as the therapy lasts. Once the therapy is over, using condoms is recommended until the local therapy is finished (local therapy includes using vaginal suppositories for three days after your period).
In order to prevent fungal infection you should use intimate care and hygiene products that will not disturb natural vaginal flora, avoid wearing thongs and underwear made of synthetic materials, and every time you use antibiotics apply vaginal anti-fungal tablets.
Another reason for painful intercourse can be uterine fibroids. Fibroids are benign tumours developed from the muscle tissue in the uterus that can cause symptoms, but in most cases are asymptomatic. Symptoms that do occur are lower back pain during menstrual bleeding, occasional sharp pain in the abdomen and increased urination. Women with fibroids complain about painful sex three times more often than women who don’t suffer from this problem. Final diagnosis should be confirmed with an ultrasound, while a decision regarding therapy that should make sexual intercourse pain-free, is based on the intensity of the symptoms and patient’s age. A small fibroid, not causing any symptoms or complications, may be treated using hormone therapy. This type of treatment can shrink fibroid tissue in around 50% of patients, which is considered satisfying therapeutical efficiency. This option is used if the patient plans on having children, if there are reasons against a surgical procedure or as preparation for surgical removal of the fibroid or an entire uterus.
Large fibroid, causing symptoms and complications should be treated surgically. This procedure can involve removing only the fibroid itself (fibroidectomy) or the entire uterus (hysterectomy), depending on previously discussed factors and patient’s desire to have more children.
Women who had episiotomy whilst giving birth are at bigger risk for experiencing pain during sex. This painful sensitivity shouldn’t last longer than three months after the delivery. If the pain persists, you could try massaging the painful area once a day using a lubricant. Massage will desensitise nerve endings and make skin more elastic. If this treatment shows no results, you should use an anaesthetic cream on the painful area prior to having sex, which should reduce pain. If none of these treatments are working, the final option is a surgical procedure that will remove the sensitive tissue.
Dyspareunia can also be caused by endometriosis – a condition when endometrium cells covering the mucous membrane of the uterus, are found outside of the uterus, where they develop throughout the menstrual cycle like a normal endometrial cell. This condition can be treated surgically or with medication. Therapy usually starts with pain killers that should reduce symptoms, before determining a final diagnosis. Mild cases can be efficiently treated with hormone therapy. Since endometriosis is often encouraged by excessive amount of oestrogen that has a role in restoring uterine mucous membrane, your physician may prescribe gestagens or contraceptive pills. This therapy can last up to 6 months in more advanced cases. In certain cases, the only effective therapy is surgical procedure.
Women going through perimenopause or postmenopause can also experience painful sex due to vaginal dryness. As the hormone levels drop, vagina is changing – themucous membrane atrophies and loses its elasticity. Some women may experience itching and burning, and it may take longer for their vagina to lubricate itself when having sex. Vaginal dryness can cause pain during intercourse, but it also increases a chance of infection. There are products on the market containing oestrogen that are applied locally, that your gynaecologist may recommend to you – these are applied into the vagina, they promote lubrication and reduce pain during intercourse.
Vaginal dryness can also develop in the reproductive age in women using antidepressants and oral contraceptives. These women may experience lowered libido and lack of sexual arousement. Women with low oestrogen levels can also experience pain during sex. These issues disappear once the therapy causing vaginal dryness is discontinued, or in other cases, once the woman stops nursing a child. In the meantime, water-based lubricants should offer relief.
Retroverted uterus, intestine inflammation, Bartholin’s gland inflammation – all of these conditions can cause discomfort and pain during intercourse and require appropriate therapy.
Considering many possible causes behind painful intercourse, diagnosis is based on a detailed medical history, considering when the symptoms began, their intensity and type, as well as a thorough clinical exam and appropriate diagnostic procedure. Treatment is complex and it often requires a multidisciplinary approach, where specialists (gynaecologist, psychiatrist, endocrinologist, urologist, etc.) may be required to work together. Foundation for a successful treatment is an open and honest relationship between sexual partners, as well as trusting your physician.