Painful Sex

Anatomy of a response

Advice from the American College of Obstetricians and Gynecologists

February, 2004

Pain during sex isn't a preserve of the elderly. About one in three women going through the first stages of menopause say sex is painful, and many of these women are still in their 40s. Further, nearly two out of three women say sex at some point in their lives has been painful, according to the American College of Obstetricians and Gynecologists (ACOG). The pain may start at the opening of the vagina, in the mid- vagina or deep inside this organ. ACOGS' Patient Guide (reprinted below) tells you more about its causes.

Pain During Intercourse

When a woman feels pain while having sexual intercourse, it is called dyspareunia. Painful sex is fairly common. Nearly two out of three women have it at some time during their lives. The pain can range from very mild to severe.

Why You May Feel Pain

Painful sex can have both physical and emotional causes. To understand why the pain occurs, you should know what happens to your body during sex.

A woman's body follows a regular pattern when she has sex. There are four stages:

1. Desire - The feeling that you want to have sex.
2. Arousal - Physical changes take place. Your vagina and vulva get moist, and the muscles of the opening of the vagina relax. The clitoris swells and enlarges. The uterus lifts up, and the vagina gets deeper and wider.
3. Orgasm - The peak of the response. The muscles of the vagina and uterus contract and create a strong feeling of pleasure. The clitoris can feel orgasm, too.
4. Resolution - The vagina, clitoris and uterus return to their normal state.

Types of Pain and What You Can Do

During sex a woman may feel pain in the vulva, at the opening of the vagina, within the vagina or deep inside. Vulvar pain is felt on the outside of the vagina. Vaginal pain is felt within the vagina. Deep pain can occur in the lower back, pelvic region, uterus and bladder.

Vulvar Pain

Pain can occur when some part of the vulva is touched. The vulva may be tender or irritated from using soaps or over-the-counter vaginal sprays or douches. Other causes include scars, cysts or infections.

Vaginal Pain

Vaginal dryness. The most common cause of pain inside the vagina is lack of moisture. This can occur with certain medications, with certain medical conditions or because you are not aroused. It can occur at certain times of your life, such as during or just after pregnancy, while breastfeeding or near or after menopause.

Vaginitis. Another cause of vaginal pain is vaginitis - an inflammation of the vagina. The most common symptoms of vaginitis are discharge, itching and burning of the vagina and vulva. Vaginitis has many possible causes, such as yeast or bacterial infection.

Vaginismus. Vaginismus is a spasm of the muscles at the opening of the vagina. It causes pain when your partner tries to enter the vagina. In some cases, vaginismus is present the first time a woman has - or tries to have - sex. The pain also may occur during a pelvic exam.

Vaginismus also can be a response to a fear of some kind, such as being afraid of getting pregnant.

Deep Pain

Pain that starts deep inside may be a warning sign of an internal problem. Pain that happens when the penis touches the cervix can have many causes:

• Pelvic inflammatory disease (PID)
• Problems with the uterus
• Endometriosis
• A pelvic mass
• Bowel or bladder disease
• Scar tissue
• Ovarian cysts

How Emotions Play a Role

Pain during sex sometimes can be linked to a state of mind. Emotional factors, like memories or fears, can keep you from relaxing. Some women may feel guilty having sex. Or, some women may be afraid of getting pregnant or getting a sexually transmitted disease (STD). Sometimes, a past bad sexual experience, such as rape or sexual abuse, may be the cause. All these factors may make it hard to relax during sex. This prevents arousal and lubrication.

Finally … Pain during sex is a sign there may be a problem. Talk to your doctor about the pain so that the cause can be found and treated as soon as possible. Proper treatment can help you enjoy your sex life.

This information has been reprinted, with permission, from the Patient Education Pamphlet prepared by the American College of Obstetricians and Gynecologists. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist. Copyright 1999 The American College of Obstetricians and Gynecologists.