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Pain during sex: Why it happens and when to see a doctor

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Posted by Alex Daly on Aug. 5, 2019

Is pain during sex normal? The American College of Obstetricians and Gynecologists estimates that nearly three out of four women experience pain with intercourse, so it’s a very common issue that can arise at just about any age, including during and after menopause. But just because it’s common — or difficult to talk about — doesn’t mean it’s something you should ignore. 

If you find that you have been avoiding intercourse because of pain, it’s important to seek treatment with the help of a doctor or medical provider. In many cases, pain during sex is treatable with medication or other therapies. 

Healthcare professionals define painful intercourse, known medically as dyspareunia, as persistent or recurrent genital pain that occurs just before, during or after intercourse. While pain during sex can be challenging to diagnose, most treatment for painful sex focuses on identifying the source of the pain and trying to eliminate it. Here’s a rundown of what you should know about pain during sex as well as the various treatments available. 
What types of pain can happen with painful intercourse?

Many different symptoms and various types of pain can occur with interercourse. You may feel pain in your vulva, in the area surrounding the opening of your vagina, or within the vagina itself. It’s also possible for pain to appear in your lower back, pelvic region, uterus or bladder. 

Common symptoms of painful intercourse include:

  • Pain during initial penetration
  • Deep pain during thrusting
  • Burning or aching pain
  • Throbbing pain that continues after intercourse

What causes painful intercourse?

There are many different causes of painful intercourse that range from physical ailments to emotional triggers. What causes painful sex for one woman might differ for another woman. Pain during sex, for example, may be a symptom of a gynecologic problem that can be treated with medication. It might also be caused by a lack of arousal or lubrication problems, which is particularly common for women who are going through menopause. 

Several reasons behind painful intercourse include:

  • Lack of lubrication. Lower estrogen levels from menopause, childbirth or breastfeeding can all affect a woman’s lubrication levels. 
  • Medications. Antidepressants, high blood pressure medication, sedatives (medications that induce sleepiness), antihistamines (such as allergy medicines), and even birth control pills can affect mood, lubrication and arousal levels, and therefore make sex more uncomfortable. 
  • Injury, trauma or irritation. Any disruption to the pelvic region or infection in the genital region or urinary tract can cause painful intercourse and should be checked out by a medical professional. 
  • Medical illness. Several gynecological conditions or ailments that affect many women can also trigger painful intercourse; these include: endometriosis, vulvodynia, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids, vaginitis and ovarian cysts. 
  • Surgeries. Scarring from pelvic surgery, such as a hysterectomy, can cause painful intercourse. 
  • Emotional factors. Anxiety, depression or relationship problems can contribute to a low level of arousal and result in pain.
  • Stress. A woman’s pelvic floor muscles can tense up during stressful times, which can contribute to pain during sex. 
  • Sexual abuse. Sexual abuse, past or present, is a traumatic event in a woman’s life that can make having sex difficult. 
  • Childbirth. Having a baby can cause pain during sex that may last for several months after giving birth, especially if there is an injury to the perineum during childbirth.

When is it important to see a healthcare professional?

If you have been experiencing pain during sex -- whether severe or mildly disruptive -- you don’t have to suffer through it. Make an appointment with a primary care provider or gynecologist to identify the conditions that are causing your pain and talk about possible treatments to help you feel better. 

Your doctor or provider will look through your medical history and ask questions about the type of pain you are having. Your doctor may ask specific details about your pain — such as when it started, what type of pain it is (aching or burning, for instance), what other symptoms you’re experiencing (such as changes in your menstrual cycle), or if specific instances trigger the pain. Your medical provider will likely ask questions about your sexual history. Try and be as candid as possible in order to help your provider pinpoint the cause of your pain. 

Next, your provider will likely do a pelvic exam to visually check for signs of irritation, infection or an anatomical problem. Depending on the origin of your pain, your provider might want to do a pelvic ultrasound or additional tests. 

What kinds of treatments are available for pain during sex?  

Depending on the cause of your pain, prescription medications are a possible treatment option. Many women who’ve gone through menopause, for example, find that painful sex is caused by inadequate lubrication and low estrogen levels. Possible treatments for painful sex during menopause include: 

  • Topical estrogen, applied as a cream to the vagina
  • Inserts with low-dose estrogen, such as an applicator-free vaginal insert, tablet , or ring
  • Estrogen-like pills or other oral medications

In addition, behavioral techniques can sometimes help minimize pain, such as physical therapy exercises designed to relax the muscles around your vagina. Counseling and sex therapy can also be helpful, especially if the lack of sex is taking a toll on your relationship. If you and your partner have avoided intimacy because of painful intercourse, talking to a counselor or therapist can help restore intimacy to your relationship and improve communication. 

Many treatments involve more than one approach such as a combination of medication, cognitive behavioral therapy and/or physical therapy. 

Are there any at-home treatments to help relieve pain during sex?

Depending on your case and the cause of your pain, you might also consider:

  • Lubricants. If natural lubrication is a problem, your doctor will be able to prescribe lubricants that might make sex less painful. 
  • Trying new sexual positions. One position might be the cause of pain, whereas others aren’t. 
  • Self-care. Have a warm bath before intercourse or take an over-the-counter pain reliever.
  • Ice. You can try applying ice or a gel pack to the vulva after sex.

With multiple medications and treatments available for addressing painful sex, you might feel overwhelmed, but seeing a doctor can help decide the right one for you. Book an appointment with a provider today. 

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