Pain experienced in the genital area or the lower abdomen during sexual intercourse
Many women experience painful sexual intercourse, known as dyspareunia, at some point in their lives. The pain may be superficial, in the vulva or vagina, or deep in the pelvis. It may have either a psychological or a physical cause.
For many women, superficial pain during sexual intercourse may be caused by psychological factors, such as anxiety disorders, guilt, or fear of sexual penetration. These factors can also result in vaginismus.
There are many physical causes of superficial pain during intercourse. A fairly common cause is vaginal dryness. This problem may result from insufficient sexual arousal before penetration. It may also be a side effect of certain drugs, such as some antidepressants, or be due to hormonal changes after childbirth or the menopause (see Menopausal problems). Many women find intercourse painful for some time after giving birth, especially if they had a vaginal tear. Pain during a woman’s first sexual experience is common, particularly if the hymen is intact.
Superficial pain during intercourse may also be caused by infections of the urinary tract or the genitals, including cystitis, trichomoniasis, and vaginal thrush. In rare cases, an abnormally shaped vagina may make sexual intercourse painful.
Pain that is felt deep within the pelvis during intercourse may be due to a disorder of the pelvic cavity or of the pelvic organs, such as pelvic inflammatory disease, fibroids, or endometriosis. Another possible cause of pain may be an intrauterine contraceptive device that is incorrectly positioned in the uterus (see Using contraceptives).
Despite common belief, a large penis does not make sex painful, although certain sexual positions can cause pain in the vagina and vulva or deep in the pelvis.
If you think your pain is due to vaginal dryness caused by lack of arousal, you may need to talk to your partner about spending more time on foreplay (see Communicating your sexual needs). Alternatively, you may find it helpful to use a lubricant, particularly after childbirth and during and after the menopause. If certain sexual positions cause discomfort, try other ones.
If you consult your doctor, he or she may take swabs from your vagina and cervix to test for infection and may arrange for ultrasound scanning of the pelvis to look for abnormalities. If pain is due to an underlying disorder, the disorder will be treated if possible. If the pain is due to vaginal dryness caused by a drug, your doctor may prescribe an alternative. If no physical cause is found, your doctor may refer you for sex therapy with your partner. In most cases, the pain ceases following treatment.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.