Pain During Sex

There are different reasons for feeling pain when having sex. These depend on whether you feel pain in your vagina when you are penetrated or deeper inside during sexual intercourse. It’s not just intercourse that can be the issue - any penetration, including using sex toys, inserting fingers, or inserting tampons into the vagina can cause pain for various reasons.

If you feel pain upon entry in and around the vagina, it could be due to:

• thrush
• a urinary tract infection (UTI)
• a sexually transmitted infection (STI) such as herpes or chlamydia
• in younger women - vaginismus, a condition where the vaginal muscles tighten up making penetration painful or uncomfortable
• in older women - menopause, which can cause vaginal dryness due to a lack of oestrogen
• irritation caused by allergies to latex condoms or spermicides
• irritation caused by an allergy to soaps, shower gels and shampoos
• not being lubricated enough because of a lack of foreplay
• female circumcision (also known as female genital mutilation or FGM)
• a surgical cut made during childbirth to expand the opening to the vagina (episiotomy)
• congenital abnormalities where the vagina does not form fully
• certain medications including some contraceptive pills; antidepressants; antihistamines; sedatives; high blood pressure treatments
• skin conditions such as eczema

If you are experiencing pain deeper inside the pelvic area when having sex, there are a number of reasons for this including:

• ovarian cysts
• a urinary tract infection such as cystitis
• scarring from surgery on the pelvic area (for example hysterectomy)
• endometriosis - a condition which causes painful periods
• uterine fibroids
• pelvic inflammatory disease (PID)
• constipation
• haemorrhoids
• irritable bowel syndrome (IBS)
• certain sexual positions

Our emotional state of mind is closely linked to sex and how we feel about it. If an obvious or underlying physical problem is not determined as causing you to experience pain during sex, you may have emotional reasons for finding sexual intercourse difficult or painful.

Talking to your doctor or medical professionals at your local genitourinary medicine (GUM) clinic can help you to get to the root of the problem, whether physical or psychological. The best course of treatment can then be decided upon.

Lots of women say that sex feels different when they are pregnant. Your genitals can feel hypersensitive because of the increased blood flow to the pelvic area that occurs during pregnancy. Although in theory this should make sex more pleasurable, for some women the heightened sensitivity makes sex feel uncomfortable, though not necessarily painful.

Pregnant women’s breasts can feel much more sensitive than usual. They may ‘tingle’ or feel tender when touched. Some women don’t like their breasts being touched because they feel so sensitive during pregnancy, which can make it hard to get in the mood for sex. Some women experience mild abdominal cramps during or straight after they have sex while pregnant.

Pregnant women might be worried that intercourse could harm the baby. Although it is highly unlikely that your baby will be harmed in any way by your partner’s penis, worries about it could put you off sex.

If you do feel any pain or discomfort during sex while pregnant, talk to your partner. There are other ways to create sexual intimacy, without penetration.

If you are concerned about any pain or stomach cramps during or after sex while you’re expecting, talk to your doctor or midwife.

If you have experienced a difficult birth then it may be some time before you’re ready to have sex again. Doctors advise waiting six weeks after giving birth to have sex to give your body a chance to recover.

If you had an episiotomy (a surgical cut to widen the vaginal opening and make more room for the baby to come out), or you had a tear and had to have stitches, then having sex less than six weeks after birth would be inadvisable and very painful. Waiting until the area has fully healed is important and you should have your 6 week postnatal check by your doctor who will then advise you.

Some women may still find sex painful after giving birth, and may experience problems with sexual arousal. Using a lubricant can help to make sex more pleasurable after giving birth. Trying positions that allow you to control the depth of penetration, such as going on top or lying side by side, can also help to make sex more comfortable after you’ve had a baby.

The most common reason for pain during sex in women over the age of 50 is vaginal dryness and a reduction in the vagina’s ability to expand and contract and grow new cells. This is caused by the lowering of oestrogen during menopause.

Known as vulvovaginal atrophy, the lower oestrogen levels attributable to menopause eventually lead to a shrinking of the vagina and vulva. This can result in sex feeling uncomfortable or painful, a burning sensation after sex and sometimes bleeding after sex too.

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause, which include the vaginal dryness that contributes to painful sex.

If you are only experiencing vaginal dryness as a result of going through the menopause, your doctor may recommend that you use ‘local’ low dose oestrogen treatments to help you to feel more comfortable during sexual intercourse. These are inserted into the vagina or applied to the vaginal area and come in the form of:

• pessaries
• a vaginal ring
• vaginal creams

Men can also find sex painful. Sexually transmitted infections and other infections such as thrush can make sex feel painful for men. There are also other reasons that men may find that their penis hurts or feels uncomfortable during sexual intercourse. These include:

• a tight foreskin
• damage to the foreskin (such as unseen little tears)
• prostatitis - inflammation of the prostate gland
• swollen and painful testicles
• priapism (a prolonged and painful erection)

If you find sex painful, as a woman or as a man, help is at hand. Talk to your doctor or the medical professionals at your local GUM clinic who can diagnose the problem and recommend the best course of treatment for you.