Painful Sexual Intercourse

Describe painful sexual intercourse, its causes and treatment.
In general you make love for fun because it feels good. But it can happen that it doesn't feel good anymore and it even hurts. The cause of the pain is often unknown and the solution for it also. Due to the pain the person often doesn't want to make love anymore or does make love, but with a lot a pain. This means that the desire to make love is often reduced.
The pain can be present at various moments of the love play and often feels burning, cutting or stinging. This problem occurs more often in women. There are two sorts of pain in women: superficial and deep pain. When there is superficial pain in the sexual contact there is pain in the outer or inner labia or at the entrance to the vagina. For some women the pain is so strong that they also experience pain at every touch in this area, e.g when inserting and removing tampons, in gynaecological investigations, when riding a bicycle or when sitting on a hard surface. The gynaecologist can sometimes induce the pain by touching the area with a wet cotton stick. The pain then feels the same as when making love.
With deep pain the woman has a painful feeling deeper in the abdomen when making love, sometimes described as 'at the bladder' or 'at the ovaries'. The pain is often experienced as dull, stinging or pressing. However, the superficial pain occurs more often and has a physical cause less often.
Men can also have pain while making love.

How common is painful sexual intercourse?
An estimated 8 to 33,5% have severe pain while making love. 10 to 20% of the women who visit a gynaecological polyclinic have sexual pain complaints when the doctor asks about them directly.

What are the causes of painful sex?
To be able to make love without pain, there must be sufficient desire to make love and sufficient arousal. The woman must have relaxed pelvic floor muscles and there shouldn't be any irritated body parts e.g a bladder infection, venereal diseases, insufficient lubrication of the vagina, oedema, a tight foreskin etc.
It is important to look at the problem from different points of view. There may be a biological cause. This may be a sexually transmitted disease, a vaginal infection, a disorder of the uterus or the large intestine, an infection of the vaginal mucous membrane, a snip or a tear during childbirth and insufficient lubrication of the vagina. Men may have infections on skin anomalies to the penis, infections of the glans and the foreskin due to fungi or bacteria, a tight foreskin, prostatitis, or a low testosterone level (hormones). In women, vestibulit (an inflammation in the vagina) can be a cause of sex pain.
A medical investigation is an important step in the treatment process. The pain may be due to social causes like relational problems. Communication problems between the partners may play a role. Many people are afraid to indicate what they like in the sexual field. Psychological causes may also play a role. Since many women can't relax sufficiently, the vagina doesn't get wet enough the penis rubs against the side of the vagina, which leads to irritation. Due to the fear of pain the pelvic floor muscles are tensed too much, which causes the love play to hurt. The woman gets into a vicious circle of fear of pain, which leads to tension, the tension to extra pain and no more arousal, which leads to a dry vagina, which leads to more irritation, etc. There may also be negative thoughts and feelings about sexuality and certain harmful events may play a role.
Vestibulitus and vaginismus are other possible causes of pain during sex.
For men who can masturbate without pain, physical causes may often be excluded. Fear of pain may lead to the avoidance of the pain by not wanting to make love anymore.

Sex Pain in a Woman can be a Symptom of Vestibulitis.
When a woman is in such a pain that it feels as if her vagina is beeing torn apart during intercourse, the reason could be that she has or is about to develop vestibulitis.
Pain during intercourse affects many women but there is no single explanation. The pain can be mild or strong. Vaginal thrush and intercourse without enough lubrication is usually associated with the problem. Lubrication is the female equivalence to erection. It makes her organ filled with blood and it becomes wet.
Vestibulitis is a condition that often makes intercourse entirely impossible. Some women can't even ride a bike or wear trousers. If the woman continues having intercourse despite of the pain, there is a risk that it might get worse. This makes it really important to look for help. Pain during intercourse must be taken seriously and anyone experiencing pain during intercourse should contact a gynaecologist.
Everyone working with healthcare should be aware that vestibulitis does exist, but this condition is not always taken seriously. The treatement of vestibulitis is not yet sufficientlely developed. There is no optimal cure for the moment, but it can be cured. Contact a gynaecologist, and if you think that your doctor is not taking the problem seriously, try getting in touch with another. It is common that women with vestibulitis are adviced to use lubrication but it could make the condition worse if the real cause is vestibulitis.
If a woman says that she has a tearing pain in her genital area during intercourse, then everything isn't right, irrespective of if the reason is psychological or physical. Therefore, it is important to visit a gynaecologist.

Treatment of Painful Sexual Intercourse.
It is important not to make love when it hurts. Pain indicates the existence of a problem. Consult a gynaecologist or urologist for possible physical causes. And it is important to talk to the partner about the problem. Determine whether you are satisfied with the way you make love and about the relationship with your partner.
The treatment of a sexologist consists in searching for a possible cause of the problems and making the person aware of restraining, negative thoughts while making love and their consequences. The sexologist gives tips about how to deal with irritation of the vagina, e.g not washing the vagina with soap, wearing cotton underwear, hygienic toilet measures, etc. There are relaxation exercises and learning how to get control over the pelvic floor muscles. You will also get individual and couple related exercises to relearn again how to enjoy physical contact without fear of pain.
Women with vestibulitis should go to a clinic which specializes in the treatment of vulva problems. Such clinics sometimes have a gynaecologist, sometimes a skin doctor. It is very important to get to a clinic which has special competence on this specific problem. A combination of medical and psychological help is often needed.
Vestibulit is not always easy to treat. If a woman with vestibulit wants to try sexual intercourse, silicon-based lubricants are often better than water-based lubricants. Women with vagnismus need support in accepting the kind of sexuality which suits them. They need to know that it can be right to do without vaginal intercourse without having guilt feelings, and to experiment with other alternative ways of making love. Later on, they may be able to accept vaginal sex. For some women, help from a physiotherapist to learn to understand their bodies. Massage and acupuncture and similar treatments can sometimes also help.