Painful Intercourse? Here’s Why
We are complex beings, and sex is definitely not simple either. Often times we underestimate the many things that fall into place, physically and psychologically, for us to have a pleasurable sexual experience.
Having a ‘functioning’ sexual response is frequently intertwined with the emotional feelings of desire and pleasure.
Dr. Jennifer Adams MD FRCSC, Maud’s education lead and a board certified gynecologist, joins us to discuss some of the reasons for painful intercourse, called “dyspareunia”.
It’s not just physical!
The first possibility could be vaginal dryness. While we produce natural lubrication when aroused, arousal is a journey that takes foreplay and mental stimulation as well as physical. Foreplay not only encourages natural lubrication, but also gives time for the vagina to widen and elongate, resulting in more pleasurable intercourse.
Vaginal dryness can also be caused by changes in the vagina due to menopause or a decrease in estrogen. There are so many possible treatments, like adding lubricants, vaginal moisturizers, vaginal estrogen or vaginal laser therapy. Lubricants and moisturizers suppliment the vaginas natural lubrication to add moisture, while vaginal estrogens and lasers change the architecture of the vagina on a cellular level that allows it to form more glycogen cells and therefore ‘create’ its own moisture (similar to pre-menopause levels).
Another reason for pain during intercourse could be muscle tightness, our pelvic floor muscles control the bodily functions in our pelvic region, tightness or increased tone of these muscles can lead to pain as the vaginal muscles can involuntarily contract. When sex is painful, or sometimes intercourse is impossible, due to the involuntary contraction of our vaginal muscles the condition is called vaginismus. People can have always had vaginismus, or it can develop later in life, usually as the body’s response to previous trauma. It’s like now we would never keep our hand on a hot stove! Our bodies know to retract away from pain to protect itself, the same goes for vaginal pain.
Working with your gynecologist and a pelvic floor physiotherapist can help you retrain the musculature around the vagina to treat pain caused by vaginismus.
A lesser known cause of painful intercourse is also the source of painful periods, endometriosis. This term is commonly heard, but what is it? Endometriosis is is a condition where cells that resemble the cells that grow inside the uterus (endometrium) grow outside the uterus. These stray cells most often stay within the pelvis, but the cells can propagate almost anywhere in the body (even in the lungs!). These cells can cause inflammation and scarring within the pelvis, which is what usually leads to pain. People with endometriosis frequently experience painful periods as well as painful intercourse. Typically (but not always), dyspareunia caused by endometriosis feels like a deeper pain, as opposed to a shallow/penetrative pain like that caused by vaginismus or dryness.
Many treatments exist for endometriosis, like menstrual suppression with hormonal contraception (like birth control pill or and IUD), and surgical treatments.
Always talk to your doctor if you have any concerns, as treatments for endometriosis are often more effective when caught early.
Disclaimer: The content offered in this post is the content of Dr. Jennifer Adams, with edits for clarity and brevity.
The information given is not exhaustive and are potential ideas to begin to address sexual topics and concerns. The answers are not meant to replace medical advice, and are included for educational and entertainment purposes only.
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