This educative article is excerpted from “Everything You Always Wanted to Ask Your Gynecologist” by Scott Thornton, M. D. & Kathleen Schramm, M. D. A must read book for every lady.
It is particularly distressing when you experience pain during sexual encounters. What should be intimate and pleasurable is transformed into a frightening, painful experience. This extends beyond the physical pain to affect your emotional well-being. If the problem is recurrent, it may also strain a relationship. This educative article addresses various causes for painful intercourse from the most common causes down to the obscure ones.
Insufficient Lubrication
The most likely cause for discomfort in the vagina during inter- course is insufficient lubrication. Vaginal lubrication naturally happens as sexual arousal occurs; the vagina moistens with secretions produced by the vaginal walls. Without adequate foreplay, lubrication will not occur. Some men think getting undressed constitutes ample foreplay, so you might have to give your partner a clue as to what is required for you to become stimulated. Sexual arousal is more difficult when you are anxious, so try to initiate sex in a relaxed setting. Vaginal dryness is normal at some points in life.
The weeks immediately following childbirth are one such time. If you breast-feed your infant, dryness will continue longer. As your estrogen production resumes, the problem will correct itself. You will also develop vaginal dryness at menopause. Estrogen replacement will help, if you choose to pursue hormonal replacement therapy. Vaginal moisturizing creams (Replens and Gyne-moistren) can be purchased over the counter for generalized vaginal dryness. However, if your problem painful intercourse, you should use a lubricant. Lubricants can be purchased without a prescription in the form of a cream, jelly, or suppository.
The cheapest is ordinary K-Y jelly, which gynecologists often use for examinations. All lubricants are water-based preparations that do not stain and clean up readily. Do not use a petroleum- or oil-based product such as Vaseline, particularly if your partner uses latex condoms, because the petroleum jelly dissolves latex.
Inflammation of The Vagina
Vaginitis, inflammation of the vagina, is another common cause of painful intercourse. Suspect an infection if you have vaginal burning itching. An unusual discharge or odor may also be present. Although the infection may begin in the vagina, it can spread externally to create inflammation of the vulva (called vulvitis). Examples include yeast infections, trichomoniasis, and bacterial vaginosis. Other infections cause ulceration of the vulva or opening of the vagina. Herpes and syphilis can both do this. Of the two, herpes is more likely to cause painful open sores that prevent intercourse. Genital warts (condylomata) commonly affect the external genitalia and can produce pain.
Vulvar inflammation and sensitivity can also arise from an irritant or allergic reaction. A few suggestions are worth emphasizing. Use only mild soaps without deodorants, scents, and dyes (a good choice is white, unscented Dove). Use white, unscented toilet paper. Wear white cotton underclothing, and wash your underclothing with mild detergents.
Various dermatologic diseases produce vulvar inflammation, making intercourse painful. The doctor diagnoses these either by their appearance or after a skin biopsy, which can be done in the office under local anesthesia. Your gynecologist or dermatologist can treat these with anti-inflammatory creams or ointments to reduce the inflammation.
Vaginismus
Vaginismus, painful spasm of the vagina that precludes intercourse, may also cause pain on attempted entry. Muscles at the opening of the vagina often tighten in anticipation of pain. If you have experienced painful attempts at intercourse previously, or have been sexually abused, this is more likely to happen.
The good news is that you can learn to control these muscles. Place one finger into the vagina, and attempt to contract the muscles around your finger. Now concentrate on relaxing the muscles, continue to do this until you achieve control. Once you have established control, introduce a second finger and repeat the sequence. Finally, overlap three fingers (place your second and fourth fingers under your third finger).
When you can successfully introduce three overlapped fingers and still relax your muscles, intercourse should be possible. It is important not to attempt intercourse prior to this point. If you try too soon, you will feel pain, which makes it more difficult to learn vaginal muscle relaxation.
Some women prefer to use vaginal dilators for their relaxation exercises. They are available in sets of four graduated sizes. Before attempting intercourse, concentrate on sexual foreplay to help with vaginal lubrication and relaxation. Digital stimulation, with your partner placing his fingers in your vagina, is helpful. See if you can relax your vaginal muscles while your partner puts his fingers in. You can then attempt intercourse. Don't hesitate to use a lubricant (K-Y jelly is fine), and lower yourself from above onto his penis. That way you have control over the degree of penetration. You can lower yourself slowly, stopping intermittently to relax the vaginal muscles.
Sometimes, the opening of the vagina is partly closed by the hymen, a ring of tissue located at the entrance to the vagina. Your doctor can assess this and instruct you on how to stretch the hymenal ring, using your fingers or vaginal dilators. If this is unsuccessful, the doctor can make small incisions (while you are under anesthesia) to open the hymenal ring.
A cyst or abscess in the special glands located between the labia, at the entrance to the vaginal canal in what is called the vestibule, can cause pain with attempted entry into the vagina. They can be treated with warm compresses, incision and drainage, or removal. A local or generalized inflammation limited to the vestibule, known as vulvar vestibulitis, can also be the problem. The inflammation is often over-looked on examination but causes intense pain when touched.
Urinary Tract Infections
Urinary tract infections occasionally cause painful intercourse, but not usually. The bladder and urethra lie in
direct proximity to the vagina. The opening of the urethra, called the urethral meatus, is located immediately
above the vaginal opening. Inflammation associated with cvstitis (bladder infection) or urethritis
(urethral infection) may cause pain either with initial penetration of the vagina or during inter-course.
Other common symptoms of urinary infections include frequency (you feel as if you have to run to the
bathroom every five minutes), urgency (you feel as though you'd better get there quickly or an accident),
and pain or burning when you urinate.
Pain that occurs with deep penetration is the most serious problem, as it may represent a disorder of the
internal reproductive organs. Uterine infections (not to be confused with vaginal infections) may cause with
deep penetration. Treatment consists of antibiotics. Other uterine problems such as fibroids (noncancerous
tumors in the wall of the uterus) and adenomyosis (a condition in which the inside lining the uterus grows into
the wall of the uterus) may create pain when penis hits the cervix.
Ovaries are very sensitive, and cysts or tumors the ovaries increase the likelihood of experiencing pain with deep penetration.
Endometriosis and pelvic adhesions also create pain felt deep in the pelvis. A thorough examination and pelvic ultrasound are
warranted when there is deep pelvic pain during intercourse. If the results of the tests are normal, you should
try different positions. You may have less pain if you control the degree of penetration by positioning yourself
on top during intercourse. If the problem is persistent and severe should consider laparoscopy.
Rarely, pain in the vagina results from scarring related to previous vaginal surgery or injuries incurred during
childbirth. These areas may stretch and become less painful with time. Anesthetic creams or lubricants may help.
Experiment with different positions during intercourse.
If the vagina is narrowed, vaginal dilators can be used to increase the width of the vagina. Surgery is indicated if
no improvement is seen over time. There is always a small chance that the operation will produce scarring that might
worsen the condition. Therefore, it is best to pursue conservative options before proceeding with surgery.
Emotional Factors
Finally, emotional factors can influence sexual response. Problems within a relationship, depression, anxiety, and
emotional or sexual all interfere with the natural sexual response, inhibiting relaxation of the muscles at the opening of
the vagina and decreasing vaginal lubrication. The lengthening of the vagina that occurs with a normal sexual response
may be inhibited, allowing the penis to hit sensitive structures deep within the pelvis. All of these can produce pain,
which causes more emotional distress, further restricting the natural sexual response. A vicious cycle develops, which
becomes progressively harder to break. Depression or anxiety that interferes with your sex life warrants evaluation by
a psychologist or psychiatrist. A strained relationship may benefit from marriage counseling.
Deal with the problem, and seek help early before it becomes overwhelming.
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