All You Need to Know About Painful Sex

Let’s talk about sex. Conversations involving what happens under the sheets are often deemed as a taboo topic to discuss, leading many to feel ashamed or fearful of addressing their issues.

Do you have pain during sexual intercourse? Pain could be due to a variety of gynaecological conditions. It is crucial to seek help and treatment before the condition worsens. Open dialogue and early intervention are key to maintaining physical and emotional well-being.

What causes painful sex?

Most people would have experienced painful intercourse at some point in their lives. However, dyspareunia (painful intercourse) refers to lasting or recurrent vaginal or lower pelvic pain that occurs just before, during, or after sex. Causes of painful sex include:

• Endometriosis
• Vaginismus
• Vaginal atrophy
• Skin disorders – Eczema or genital infections such as herpes

What are the symptoms?

• Pain on penetration (pain during sexual entry or other activities such as inserting a tampon)
• Deep pain in the pelvis during thrusting
• Burning or aching pain that persists hours after sex

What is endometriosis?

Endometriosis is a condition where tissues similar to the inner lining of the uterus grow outside the uterus. Delayed diagnosis of endometriosis is a well-known phenomenon, often taking up to 10 years. As a result, women often endure long-term chronic pain without appropriate treatment.

Endometriosis often affects the ovaries, fallopian tubes, and the tissue lining the pelvis. It can also cause the vagina to adhere to the rectum. The pain associated with endometriosis during sex is deep, resulting from fibrosis (thickening) and the fusion of pelvic organs with the back wall of the vagina.

Hence, the normal mobility and expansion of the upper posterior vagina behind the cervix during sex is restricted. Pain can intensify in certain sexual positions, depending on the location and severity of endometriosis. In advanced cases, pain may occur regardless of position. Once diagnosed, treatment options vary, ranging from medication to surgery, depending on the severity of the disease.

What is vaginismus?

Vaginismus occurs when the vagina suddenly tightens and contracts upon attempted insertion. It is an automatic reaction over which you have no control. This condition prevents insertion of tampons and can make sex nearly impossible and extremely painful. It is more common in women in their late teens to early 30s. There is a wide range of treatment options available to improve symptoms.

What is vaginal atrophy?

Vaginal atrophy, or atrophic vaginitis, is the thinning, drying and inflammation of the vaginal skin due to a lack of oestrogen. It commonly occurs after menopause, making sexual intercourse painful. It can also cause symptoms like urinary urgency (the frequent need to urinate) or urgency incontinence (involuntary urine leakage).

Other symptoms include vaginal dryness, burning, or discharge. In severe cases, it may lead to vaginal bleeding after intercourse. Topical oestrogen is a simple and effective treatment.

When to see a doctor?

Make an appointment with your doctor if you experience persistent pelvic pain, vaginal pain, or unusual discharge, burning, soreness, or painful intercourse that is not relieved by vaginal moisturisers or changes in position during intercourse.

How can you help your partner?

Painful intercourse can affect the relationship between you and your partner.

Early diagnosis and treatment of the underlying cause of painful sex is important. Prompt treatment helps alleviate the pain and prevents worsening of the condition.