When Love Hurts: Causes and Cures for Painful Sex
Orgasms, pleasure, sensual, and love are words often associated with healthy sex. Physical pain and hurting are not. But for the men and women who live with dyspareunia—painful intercourse—these words are all too meaningful.
Approximately 15% of women and 5% of men will experience dyspareunia at some point in their lives. Luckily, the condition is usually treatable.
Both psychological and physical factors contribute to painful sex, and treatments vary. Sometimes, something as simple as choosing a different brand of condom or discovering new foreplay techniques will alleviate the problem. In other cases, medication or more rarely, surgery may be necessary. When the cause is more psychological than physical, individual or couples therapy may be the solution.
When a Woman Experiences Pain During Sex
Vaginal dryness is often the culprit causing pain that is felt on entry but eases later on. When a woman becomes sexually aroused, glands in her vagina secrete a fluid that acts as a lubricant. Anything that disrupts this process can result in inadequate lubrication and subsequently, painful intercourse.
Other factors can cause lubrication problems, such as insufficient foreplay or changes in women's hormone levels caused by postmenopause or breastfeeding. Medications such as antihistamines can also have an overall drying effect.
Extended foreplay or more effective stimulation techniques may resolve the problem simply and easily. If not, using a lubricated condom or applying a water-soluble lubricant such as K-Y Jelly® or liquid, Astroglide gel®, or Silken Secret® gel may do the trick. Vaseline® and other petroleum-based lubricants should not be used as lubrication aids because they can decrease a condom's effectiveness and/or encourage vaginal infections. Postmenopausal women may want to consider hormone replacement therapy to alleviate dryness and pain.
Feeling pain at or near the entrance to the vagina may be the result of a vaginal or urinary tract infection, or related to scarring from an episiotomy. Spermicides, feminine hygiene sprays, douches, or tight clothing can also create soreness. Simply treating the infection or removing the irritant may solve the problem. Pain caused by an episiotomy scar may clear up on its own as time passes and the area becomes less tender. If not, surgical treatment may be a consideration.
Reproductive Tract Disorders/Vaginismus
Pain that is felt deeper inside the vagina or into the lower abdomen during intercourse may be a sign of endometriosis, pelvic inflammatory disease, or other disorders of the reproductive tract. These conditions all require prompt attention from a healthcare provider. In a few women, sexual activity triggers a sudden and involuntary contraction of the vaginal muscles, called vaginismus. The vagina clamps down, making penetration and intercourse very painful and sometimes even impossible. This is an automatic muscular response, often associated with psychological trauma. It may be linked to past experiences of painful intercourse or sexual abuse. Vaginismus can often be resolved by gradually dilating the vagina with the fingers or with specially prescribed, graduated dilators.
When a Man Experiences Painful Sex
When a man experiences pain during intercourse, it's usually when he becomes erect or as he ejaculates. As with women, a man's genital pain may originate from an infection or an irritation, such as the use of a spermicide. Inflammation of the urethra or the prostate are also common causes of pain during ejaculation. Both of these conditions can usually be medically treated.
Other infections including sexually transmitted diseases such as herpes or genital warts may cause pain while a man is getting or maintaining an erection. If a man's foreskin is inflamed or tight, it may hurt as it is retracted. When the cause of painful intercourse is an infection, the pain usually resolves with antibiotics. Sitz baths or looser clothing may also relieve pain.
Pain is sometimes associated with a pronounced curvature of the erect penis, called Peyronie's Disease. Found primarily in men age 40-60, Peyronie's Disease causes scar tissue to build up inside the penis. During erection, the scar tissue doesn't fill with blood, which causes the penis to curve. The curvature may or may not be painful, and the pain often resolves over time.
When to Seek Help
In addition to the immediate physical discomfort, the repercussions of painful intercourse can interfere with relationships and sexual compatibility. Pain can also signal a medical condition in need of attention. If simple remedies such as increasing lubrication and foreplay don't provide relief, immediately speak to a healthcare provider. Be prepared to describe when the pain began, where it's located, and what it feels like. Bring a list of the medications you take, and be sure to bring up any other medical conditions for which you receive treatment.
Don't let embarrassment keep you from seeking help. Although you may feel uncomfortable discussing sexual intimacy, painful intercourse is a common problem. Your healthcare provider or therapist has probably held similar conversations with other patients or clients. Above all, remember the intent: more fulfilling sexual intimacy.
The American College of Obstetricians and Gynecologists
National Vulvodynia Association
Psychiatry in General Practice.
The Society for Human Sexuality
The Vulvar Pain Foundation
Last reviewed May 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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