Painful sex in women

Intercourse pain, or dyspareunia, can cause problems in a couple's sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects, so the problem should be addressed as soon as it becomes evident.

What causes painful sex in women?

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant.

In some cases, a woman can experience painful intercourse if one of the following conditions is present:

• Vaginismus. This is a common condition in which there is a spasm in the vaginal muscles, mainly caused by the fear of being hurt.
• Vaginal infections. These conditions are common and include yeast infections.
• Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration, so problems with the cervix (such as infections) can cause pain during deep penetration.
• Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.
• Endometriosis. A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
• Problems with the ovaries. Such problems might include cysts on the ovaries.
• Pelvic inflammatory disease. The tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.
• Ectopic pregnancy. A pregnancy in which a fertilised egg develops outside the uterus.
• Menopause. The vaginal lining can lose its normal moisture and become dry.
• Intercourse too soon after surgery or childbirth
• Sexually transmitted infections. These may include genital warts, herpes sores or other STIs.
• Injury to the vulva or vagina. These injuries may include a tear from childbirth or from a cut (episiotomy) in the perineum (area of skin between the vagina and the anus) that is made during labour.
• Vulvodynia . Women with vulvodynia suffer chronic vulval pain. Generalised vulvodynia is pain in different areas of the vulva which occurs at different times. Vestibulodynia or vulval vestibulitis is pain in the vestibule which is the entrance to the vagina.

How can painful sex in women be treated?

Some treatments do not require medical intervention. For example, in the case of painful sex after pregnancy, wait at least six weeks after childbirth before attempting intercourse. Make sure to practise gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water based lubricants or silicone based lubricants; both are safe to use with condoms.

Some treatments for female sexual pain do require a doctor's care. If vaginal dryness is due to menopause, ask your GP about oestrogen creams or other prescription medication. Other causes of painful intercourse also may require prescription medication.

For cases of sexual pain in which there is no underlying medical cause, psychosexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding a past abuse. Your GP can refer you to a therapist on the NHS if psychological issues are affecting your sexual health.

Seek medical advice if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions.