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Pain During Intercourse

When a woman feels pain while having sexual intercourse, it is called Dyspareunia. Painful sex is fairly common. Nearly two out of three women have it at some time during their lives. The pain can range from very mild to severe.

Why You May Feel Pain
Painful sex can have both physical and emotional causes. To understand why the pain occurs, you should know what happens to your body during sex.

A woman's body follows a regular pattern when she has sex. There are four stages:

  1. Desire — The feeling that you want to have sex.
  2. Arousal — Physical changes take place. Your vagina and vulva get moist and the muscles of the opening of the vagina relax. The clitoris swells and enlarges. The uterus lifts up, and the vagina gets deeper and wider.
  3. Orgasm — The peak of the response. The muscles of the vagina and uterus contract and create a strong feeling of pleasure. The clitoris can feel orgasm, too.
  4. Resolution — The vagina, clitoris and uterus return to their normal state.


Types of Pain and What You Can Do
During sex a woman may feel pain in the vulva, at the opening of the vagina, within the vagina, or deep inside. Vulvar pain is pain felt on the surface (outside) of the vagina. Vaginal pain is felt within the vagina. Deep pain can occur in the lower back, pelvic region, uterus and bladder.

Vulvar Pain
Pain can occur when some part of the vulva is touched. The vulva may be tender or irritated from using soaps or over-the-counter vaginal sprays or douches. Other causes include scars, cysts or infections.

Vulvar pain can be classified as either acute or chronic. Acute pain usually goes away once the underlying condition is treated. Chronic pain lasts longer. Chronic pain also occurs in people in whom no underlying condition can be found.

Acute Vulvar Pain. A common cause of acute vulvar pain is a condition called contact dermatitis. This condition is a reaction to an irritating substance.  It may cause a rash, swelling, and redness. The most common symptoms are itching, burning, and pain. Treatment includes stopping the use of the irritating substance. Medications that are applied to the skin may be helpful. In severe cases, medication may be prescribed.

Other causes of acute vulvar pain include infections, skin disorders, and injuries. Infections can cause pain, itching, and irritation. Treatment of skin disorders depends on the type of disorder. Some are autoimmune disorders that are treated with special types of medications.

Chronic Vulvar Pain. Chronic vulvar pain that has no other cause is called vulvodynia. Almost 1 in 5 women may feel this kind of pain at some time. The pain often is described as burning, stinging, irritation, or rawness.

Some women with vulvodynia find relief with self-care measures. These can include wearing 100% cotton underwear, washing the vulva with water only, patting (not rubbing) the area dry after bathing, and using adequate lubrication during intercourse. If these measures do not work, treatments such as medication, relaxation exercises, and counseling can be tried. For severe cases that do not respond to other treatments, surgical treatment may be recommended.

Vaginal Pain
Vaginal dryness. The most common cause of pain inside the vagina is lack of moisture. This can occur with certain medications, with certain medical conditions, or because you are not aroused. It can occur at certain times of your life such as during or just after pregnancy, while breastfeeding, or near or after menopause.

Vaginitis. Another cause of vaginal pain is vaginitis — an inflammation of the vagina. The most common symptoms of vaginitis are discharge, itching and burning of the vagina and vulva. Vaginitis has many possible causes, such as yeast or bacterial infection.

Vaginismus. Vaginismus is a spasm of the muscles at the opening of the vagina. It causes pain when your partner tries to enter the vagina. In some cases, vaginismus is present the first time a woman has — or tries to have — sex. The pain also may occur during a pelvic exam.

Vaginismus also can be a response to a fear of some kind, such as being afraid of getting pregnant.

Deep Pain
Pain that starts deep inside may be a warning sign of an internal problem. Pain that happens when the penis touches the cervix can have many causes:

  • Pelvic inflammatory disease (PID)
  • Problems with the uterus
  • Endometriosis
  • A pelvic mass
  • Bowel or bladder disease
  • Scar tissue (adhesions)
  • Ovarian cysts

How Emotions Play a Role
Pain during sex sometimes can be linked to a state of mind. Emotional factors, like memories or fears, can keep you from relaxing. Some women may feel guilty having sex. Or, some women may be afraid of getting pregnant or getting a sexually transmitted disease (STD). Sometimes, a past bad sexual experience, such as rape or sexual abuse, may be the cause. All these factors may make it hard to relax during sex. This prevents arousal and lubrication.

Sex therapy may be recommended separately or with your partner, even if you are receiving treatment for a medical condition. A sex therapist can help you and your partner resolve the emotional, physical, and medical aspects of a sexual problem. To find a qualified sex therapist, go to the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) web site at http://www.aasect.org.

Finally …
Pain during sex is a sign there may be a problem. Talk to your doctor about the pain so that the cause can be found and treated as soon as possible. Proper treatment can help you enjoy your sex life.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months

Copyright © July 2010 The American College of Obstetricians and Gynecologists

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