When sex hurts for a woman

Possible causes and what to do

‘My boyfriend and I have been going out for six years. Our sex life was amazing in the first few years. Now it just hurts me all the time. He gets so upset when I don't want to do something because it hurts so much. Is there something I can take to help ease the pain or should I see my gynae for help? Our sex life is on a downward spiral that we can't seem to fix!’ Pain is not the norm Sex shouldn’t hurt and if it does, this is a sign that something is wrong.

Photo: jtravism / flickr

Pain may be experienced in the vagina, in the vulva (the external ‘lips’ near the entrance to the vagina) or deep in the pelvis. Penetrative intercourse can feel painful from both vaginal and pelvic conditions.

It is estimated that in the course of our lives, two-thirds of women occasionally experience pain during or after penetrative intercourse. In the majority of cases (about 90%), there is a physical cause for the pain, but emotions can also play a role. It is not the norm to endure ongoing discomfort, however, and if this is the case a medical practitioner should be consulted to investigate and treat the cause. It’s also wise to tell your partner so they are aware of what you’re experiencing and why you may not be so keen to have penetrative intercourse.

Potential causes
There are many possible reasons for painful sex, including an infection, irritation, dryness, tightness, vaginismus, a painful clitoris, pelvic pain and emotional causes.

Vaginal infections
One of the most frequent causes of such pain is a vaginal infection such as a yeast infection, chlamydia, trichomoniasis or genital herpes. It is possible to have an infection without any obvious symptoms but these symptoms may become noticeable with friction from penetrative intercourse, such as itching, burning or stinging. There may also be an abnormal vaginal discharge. A trip to your medical practitioner will determine if you have an infection, whether or not any symptoms are present. A yeast infection can be treated with an over-the-counter cream, but it is better not attempt a self diagnosis.

Vaginal irritation
A second source of pain is vaginal irritation cause by products such as scented tampons, washing powder, vaginal douching, vaginal deodorants, scented soaps, allergies to condoms or diaphragms and contraceptive creams or jellies. Generally, douching is a bad idea as the vagina is designed to self clean. Women who are sensitive to products, especially scented products, should refrain from using these. A mild, unscented soap is advisable for washing the external genitals or vulva.

Vaginal dryness
If the vagina is dry during intercourse, this can make sex painful. Most women lubricate when they are aroused but at certain times the vagina may be dry on penetration, making it painful. One of the main causes is attempting penetration too soon before she has been aroused sufficiently to lubricate. Another reason may be that she is anxious about sex, blocking the release of lubrication. Alternatively, if a condom is used without adding lubrication (saliva or a store-bought lube), or a hormonal imbalance caused by childbirth or approaching menopause (prescribing a vaginal estrogen cream may be helpful). Diabetes can lead to a lack of vaginal lubrication. At certain points during the menstrual cycle, vaginal dryness may also occur. Over-the-counter lubricants can help alleviate the dryness.

Vaginal tightness
Feeling tense or not totally relaxed during penetration may make penetration of the vagina difficult, even if sufficient lubrication is present. This may also be the result of an unstretched hymen.

Vaginismus
Some women have strong, involuntary muscle spasms in the vagina which make penetrative intercourse and any type of penetration difficult or painful, including with a tampon.

We have sex once in six months, if at all, due to the fact that no matter what we try, it’s painful for me and no pleasure at all. My muscle at the entrance to my vagina pulls tightly closed. I sometimes can’t even get a finger in there, let alone anything else. No matter how relaxed I am, no libido enhancers, muscle relaxants, vibrators, lubricants or anything else, seems to work. If he manages to get in, I dont feel anything at all. Doctors and gynaes have “looked” but said nothing's wrong.

This affects 2-9% of women and is very successfully treated via a programme that involves learning to contract and relax the thigh and pelvic muscles to gain control over voluntary muscles in order to regain confidence and experience pleasure.

Painful clitoris
For most women, touching the clitoris is extremely pleasurable but for some, it is painful. Pain may be caused by poor hygiene, such as vaginal secretions collecting under the hood of the clitoris and not being washed away, leading to pain.

Pelvic pain
Some women experience pelvic pain during deep, thrusting penetration. This can be caused by a urinary tract infection (UTI or cystitis, which require antibiotics); endometriosis (when tissue from the uterine lining grows elsewhere in the abdomen); ovarian cysts (mostly benign and may disappear on their own); a tear in the ligaments supporting the uterus (caused by violent intercourse or childbirth complications); uterine fibroid tumours (hard, muscular growths inside the uterus); infections of the cervix, uterus or tubes (eg pelvic inflammatory disease); pelvic adhesions (from pelvic surgery or PID); or vulvodynia (causes burning or stinging in the vagina or vulva).

Emotional reasons
Some causes of painful sex are emotional and physical, such as dyspareunia and vaginismus (which may also be caused by a fear of sexual intercourse). Without knowing the cause, treatment may not be successful. Counselling is often helpful.  

Ongoing vaginal pain should be taken seriously and the cause should be investigated by the relevant medical practitioner. In most cases, the reason for this discomfort is easily diagnosable and readily treated.

Sources of information:
The Good Vibrations Guide to Sex - Cathy Winks and Anne Semans
About.com: Women’s Health

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