Author: Amanda Oakley FRACP, Dermatologist, Hamilton, New Zealand, 2011. Reviewed by Dr Jennifer Bradford, Gynaecologist, Sydney, Australia.
Painful sex is also called dyspareunia. Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. There are two types in women:
Dyspareunia is common and may cause considerable distress to women and their sexual partners. It may be caused by structural, infective and inflammatory diseases of the vulva, vagina and internal organs. Psychosocial factors inevitably contribute to and result from, dyspareunia.
The most common vulval skin diseases resulting in superficial or entry dyspareunia include:
Dyspareunia associated with a dry vagina or vaginal inflammation (vaginitis) may be due to:
Dyspareunia may also result from:
Deep dyspareunia means sexual pain that is felt in the abdomen, rather than in the vagina. Causes may include:
A correct diagnosis requires careful history and clinical examination of the whole body including external genitalia, and pelvic examination by a medical expert (eg, gynaecologist, sexual health physician or general practitioner) or physiotherapist. Colposcopy may be performed (this is pelvic examination using magnification and bright light). The site of pain should be carefully identified. Examination under anaesthetic may be required if discomfort is too great to allow a normal internal examination.
Investigations may include:
In many cases, no physical reason is found for dyspareunia and it is considered a pain syndrome.
Intercourse should not be painful. It's important to feel relaxed before attempting intercourse. Foreplay leading to sexual excitement relaxes the pelvic muscles, widens the vagina and releases vaginal fluids. Use liberal amounts of water-based lubricants and apply these to the penis and vaginal opening. Penetration from behind or woman-on-top may be better tolerated.
If a cause for the dyspareunia has been found, appropriate treatment should help.
An experienced pelvic floor physiotherapist can help in retraining the pelvic floor to relax using special exercises. Counselling or behavioural therapy is appropriate for some women or couples.
If vaginal intercourse remains painful, consider other sexual options including massage and mutual masturbation.
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