What Causes Pain During Sex? 5 More Causes (Part 2 of 3)

Almost half (46%) of all women have had pain at intercourse (dyspareunia). Dyspareunia or painful intercourse can be thought of as either “introital” (pain during penetration) or deep, which is experienced during the thrusting of intercourse.  Dyspareunia can be due to a number of factors, including the vestibular burning and irritation of PVD as discussed in Part 1: Common Causes of Chronic Pain.

Pain during sex can also be caused by:

  1. Thinning of the vaginal wall (atrophic vaginitis). This happens in 40% of menopausal women; in women on low hormone dose contraceptives; and following many cancer therapies. Women with this condition usually respond well to estrogen hormone replacement (if appropriate) and an isotonic non-irritating lubricant like Pre-Seed.
  2. Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS). A chronic disease with bladder pain and increased urinary urgency and frequency, thought to be due to a chemical deficiency of the cells lining the bladder. As high as 18% of women may have this condition and it is often over looked by docs. Additionally, one third of women with IC/PBS also have PVD (sorry for all the acronyms—but in short everything hurts on these gals). Therapy can be challenging and multi-facted in approach. Diet changes are important, as is use of an isotonic lubricant.
  3. Pelvic Floor Hypertonus. A chronic spasm of the muscle of the pelvic floor. It can occur on its own or secondarily as a result of past trauma. There is no conscious control over these muscle spasms. It is similar to blinking your eye closed when someone tries to touch it. Botox injections, use of vaginal dilators, and physical therapy can be successful.
  4. Vulvar Dermatologic Conditions. Contact allergies, lichen sclerosis, or autoimmune diseases. Management is disease specific. But they can be tricky to diagnose, so get a second opinion if you are told you have one of these!
  5. Endometriosis. The most common cause of deep pelvic pain in women. Treatment is medical or surgical management and requires physician expertise with the condition.

There is a great deal of variation in how women describe their genital or sexual pain. It is important that patients give detailed locations for their pain, descriptions of what it feels like and what makes it worse.

Even for myself and other Reproductive Scientists I know, it is difficult for us to clearly articulate symptoms of genital pain.  But no diagnosis or appropriate therapy can be found if the symptoms aren’t clearly defined. And often women with pelvic pain have several pathologies going on at once.

Keep a journal next to your bed and write down each day what caused pain or gave you relief. If you had pain during sex write down when and where in your body you felt it. Go back to the moment you felt the pain and experience it again to help you describe what it felt like and how long it lasted (e.g. just during intercourse or for hours afterwards).

You may also be interested in Part 1: Common Causes of Chronic Pain and Part 3: Common Sense Ways to Manage Pain During Sex

- Dr. E

Science can help us nurture and enjoy our sexual selves. 


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