Sexual Health: Dealing with Pain and Overcoming It
By: Holly L. Thacker, MD • Posted on October 08, 2020
Sexual activity pain, or dyspareunia, can cause problems in a couple’s sexual relationship. Painful intercourse or painful sexual activity can have negative emotional effects in addition to the physical pain, so the problem should be addressed as soon as it becomes evident.
What Causes Female Sexual Pain?
In many cases, a woman can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, 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 or prior trauma. Pelvic floor therapy can be very helpful with or without biofeedback
- Vaginal infections - These conditions are common and include yeast infections.
- Problems with the cervix (opening to the uterus) - The penis can reach the cervix at maximum penetration. Therefore, problems with the cervix (such as infections) can cause pain during deep penetration.
- Problems with the uterus - These 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 fertilized egg develops outside of the uterus.
- Menopause - The vaginal lining can lose its normal moisture and thickness and becomes dry and thin.
- Intercourse too soon after surgery or childbirth.
- Sexually transmitted infections - These may include genital warts, herpes sores, or other sexually transmitted infections.
- 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 labor.
- Skin disorders affecting the genitalia - Like lichen planus and lichen sclerosis
- Chronic interstitial cystitis and vulvodynia - These can cause sexual pain as well and need to be addressed and treated.
How can Sexual Pain in Women be Treated?
Some treatments for female sexual pain do not require medical intervention. For example, in the case of painful intercourse after pregnancy, wait at least six weeks after childbirth before attempting intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants like K-Y Jelly or olive oil.
Some treatments for sexual pain do require a doctor’s care. If vaginal dryness is due to menopause, ask a health care professional about estrogen creams, tablets or ring or other prescription medications. Non-estrogen therapy includes vaginal DHEA. Other causes of painful intercourse also may require prescription medications.
For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding past abuse.
When Does Female Sexual Pain Require a Doctor’s Care?
Contact your doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. For pain with no underlying medical cause, ask your physician for a referral to a certified sex counselor.
Be Strong, Be Healthy, Be in Charge!
-Holly L. Thacker, MD
Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.