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Painful Sex: Causes and Treatment

Painful Sex: Causes and Treatment

Women can experience pain during or after sex, either in the vagina or deeper in the pelvis. Pain in the vagina could be caused by:

  • an infection: thrush or a sexually transmitted infection (STI) such as chlamydia, gonorrhoea or genital herpes
  • the menopause: changing hormone levels can make your vagina dry and affect your desire for sex
  • lack of arousal at any age
  • vaginismus: a condition where muscles in or around the vagina shut tightly, making sex painful or impossible
  • genital irritation or allergy caused by spermicides, latex condoms or products such as soap and shampoo

Pain felt inside the pelvis can be caused by conditions such as:

  • pelvic inflammatory disease (PID)
  • endometriosis (when the womb lining grows outside the womb)
  • fibroids (growths of muscle and tissue in the womb) growing near your vagina or cervix
  • irritable bowel syndrome (IBS)
  • constipation

Causes and Treatments

Lets look more closely at some of the causes of pain experienced during sex and what treatments are available:

Atrophy (thinning of the vaginal walls): Entrance pain caused by atrophy is common among postmenopausal women who do not take hormone replacement medication. Blood flow and lubrication respond directly to hormone replacement. The most rapid relief of atrophy comes from applying topical estrogen vaginal cream directly to the vagina and its opening. This cream is available by prescription only. Over-the-counter lubricants and moisturizers can also be helpful. There are also oral drugs that can make vaginal tissue thicker and less fragile, resulting in less pain for women during sex. Some of these medications can raise the risk of stroke and blood clots so medical advice and follow up is essential.

Urethritis and urethral syndrome: With this condition, a woman may urinate frequently with urgency, pain, and difficulty, but a urinalysis can find no identifiable bacteria. These symptoms may be caused by chronic inflammation of the urethra (the tube through which urine exits the body) from muscle spasms, anxiety, low estrogen levels, or a combination of these causes. Using a special instrument, a doctor may dilate the urethra. The doctor may also prescribe low-dose antibiotics. At times, antidepressants and antispasmodics may also be prescribed.

Inadequate lubrication: Treatment of inadequate lubrication depends on the cause. Treatment options include water-soluble lubricants (for use with condoms; other types of lubricants may damage condoms) or other substances such as vegetable oils. If arousal does not take place, more extensive foreplay might be needed during sexual relations.

Vaginismus: Painful spasms of muscles at the opening of the vagina may be an involuntary but appropriate response to painful stimuli. These spasms may be due to several factors, including painful insertion, previous painful experiences, previous abuse, or an unresolved conflict regarding sexuality. For a woman with vaginismus, her doctor may recommend behavioural therapy, including vaginal relaxation exercises.

Vaginal strictures (abnormal narrowing): Doctors commonly see vaginal strictures after pelvic surgery, radiation, or menopause. Estrogen, or special surgical techniques may be used to treat these strictures.

Interstitial cystitis: This chronic inflammation of the bladder has no known cause; however, pain with intercourse is a common symptom. It can be diagnosed with a potassium leak test or a cytoscopy. A cystoscopy is a procedure to look inside the bladder and may distend (stretch) the bladder to examine the bladder wall. These procedures often work to clear the condition. Other treatments include amitriptyline, nifedipine, Elmiron, or other prescription drugs. Other options include bladder washings with dimethyl sulfoxide (DMSO) or other agents or transcutaneous electric stimulation (TENS) and acupuncture. Surgery is a last resort.

Endometriosis: Endometriosis occurs when some of the tissue that lines the uterus is found outside the uterus. Pain during intercourse caused by endometriosis is not uncommon.

Vulvovaginitis (inflammation of the vulva and vagina): Whether recurrent or chronic, this problem is common despite the rise in the number of over-the-counter treatments.

Causes and treatment for deep thrust pain includes two strategies

  • Pelvic adhesions (tissue that has become stuck together, sometimes developing after surgery): Pain with intercourse caused by pelvic adhesions can be relieved by surgically removing the adhesions.
  • Other causes of the pain may also involve: ovarian cysts, pelvic inflammatory disease, endometriosis, uterine prolapse, or retroversion of the uterus (uterus is tilted backward instead of forward).

NOTE: If recurring symptoms are shared with a sexual partner, both individuals should be tested for sexually transmitted diseases (STDs).

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