Author: Dr Peter England
Pain during sexual activity is known as dyspareunia, pronounced dys· pa· reu· nia.
Warning: This article mentions sexual assault.
Pain during sex can be common, if you have occasional positional pain that resolves quickly by altering your sexual position, usually this is not of concern. Unfortunately, many women do experience an ongoing situation where sex becomes painful most of the time, or on every occasion. This is clearly distressing both physically and emotionally. It naturally dramatically reduces the woman’s sexual desire (her libido), and often adversely affects her relationship with her partner.
If you are suffering with this symptom, please don’t be shy or embarrassed. Speak up and obtain a referral so something can be done about the problem. Pain during sex is not something you need to endure.
Superficial or Deep Pain?
Broadly speaking doctors classify pain with intercourse into two categories.
Superficial dyspareunia refers to pain on entry into the vagina. Sometimes the pain is intense enough to prevent entry altogether, due to pelvic floor muscle spasm.
Deep dyspareunia refers to pain felt during the act of intercourse whereby the woman feels pain deep in her pelvis or lower abdomen. Sometimes this pain may persist for a while after sexual intercourse.
Why do I have pain when I try to have sex?
There are a variety of causes both physical and psychological that can lead to pain during sex. There may be local conditions affecting the vagina: for example, thrush (candidiasis), or another type of bacterial infection in the vagina. The skin of the vulval area may be chronically irritated from using soap products, overuse of panty liners etc. leading to a sensitivity of the area due to an eczema-like reaction of the delicate skin.
With deep pain during penetration, consideration is given to the possibility of gynaecological illness including pelvic infection (including STDs), ovarian cysts or endometriosis.
What happens when I see a gynaecologist to discuss painful sex?
If you’ve made an appointment to see me to discuss issues with pain during sex, the first thing you need to know is that this is taken seriously. I will chat with you and complete a detailed history of what’s happened in the past and what’s happening now. This enables you to describe your symptoms, the frequency and severity and how it is affecting you. Sometimes a patient may realise that pain during sex started with a particular episode or partner. With your permission a careful gentle examination of the genital tract is then performed. It can be useful to take swabs to exclude infection, a pap smear if it is due and then arrange a vaginal ultrasound. This can all be performed at the initial consultation within my practice.
Depending on the findings of this assessment a management plan to deal with the cause can be discussed and started. The solution will differ depending on the cause; however, it might involve topical creams, oral medication or even keyhole surgery (laparoscopy).
What if no obvious physical cause is found for why I have pain during sex?
That’s common also and it’s OK. The pain is still real, not imagined. Often learning that you have a healthy body and normal test results can be reassuring so it’s still worth investigating. Sometimes the additional knowledge can allow you to relax enough to start to enjoy sex again.
Other times it’s not that simple. There is often a reflex contraction of the muscles of the vagina, which is partly conscious, and partly subconscious. Further attempts at sex can continue to be painful.
In this setting help from a sexual counsellor or a pelvic floor physiotherapist can help you learn to relax your pelvic floor, helping to gain confidence and return to normal sexual function.
What if I have pain during sex after being sexually assaulted?
Sometimes it becomes apparent the patient has suffered sexual assault in the past, which has caused ongoing trauma of a PTSD variety. This may have been at the hands of a trusted family member as a very young woman, or in a current or past relationship. Regardless of when the assault occurred, it can still be impacting your enjoyment of sexual intercourse.
Despite the difficulty this poses, it is important to be able to speak about this in a safe and confidential setting. Referral to a skilled psychologist and dealing with ongoing depression and anxiety related to the past assault may be the key to unlocking a return to a normal sex life.
Support is also available at 1800respect for anyone who has been the victim of a sexual assault.
For an appointment to discuss any gynaecological health concerns, call the rooms.
Author: Dr Peter England, Obstetrician and Gynaecologist.
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