Painful intercourse (dyspareunia)

Who feels pain during sexual intercourse?

Men rarely feel pain during sexual intercourse unless

� they have phimosis (where the foreskin can't be pulled back properly)
� they attempt penetration when a woman is insufficiently lubricated. Some men find they
� experience discomfort as their partner gets older unless they start using suitable lubricants.

Women, on the other hand, feel pain much more frequently. This can be near the entrance to the
vagina or on the inside.

What kinds of pain could it be?

Some women feel stinging or burning near the entrance of the vagina.
A few women experience pain every time intercourse is attempted because of extreme tension in the
genital muscles.

Another type of discomfort is sometimes referred to as collision pain. This happens when the penis
touches a sore spot in the vagina. It may hurt every time it touches or possibly only in certain positions.

There are also women who feel pain during orgasm.
And other women who only feel pain afterwards, perhaps a day later.
What causes stinging and burning near the entrance of the vagina?

If you feel a stinging or burning pain it might well be because of vaginitis (inflammation of the vagina)
caused by microscopic organisms such as a bacterium or Candida. You need to see your GP, or a clinic
about this and get appropriate treatment.

What causes pain and tightening near the entrance to the vagina?

There is a condition called vaginismus which causes a woman to tighten up her muscles at the
entrance to the vagina making sexual intercourse difficult or actually impossible. This tightening is
involuntary and can cause the woman intense distress. Frequently women suffer this condition for
years without seeking treatment. Indeed many women only finally go for help when they want to have a
baby. Some women with this problem dislike all sexual contact. But many vaginismal women actually
enjoy sex - sometimes to the point of orgasm - so long as their vaginas are left alone.

Its cause is generally rooted in the woman's upbringing which may have been very restrictive
sexually.

If you feel this way, you should contact your doctor who may send you to a psychosexual specialist -
either on the NHS or privately. You can also get help - without having to visit your own doctor - from a
Relate counsellor who deals with psychosexual matters or from a family planning clinic.

How is vaginismus treated?

A non-medical counsellor will usually treat this condition by helping you to talk about your upbringing
and about your fears concerning penetration.

But doctors who are psychosexual specialists tend to use a combination of talking and physical help.
A woman doctor may well encourage you to examine your own vagina in her presence and to
investigate how stretchy it is. She may also help you to touch yourself and - in time - to insert a finger
into your vagina. Some doctors also encourage their patients to experiment with a series of dilators,
which come in varying sizes. These train the vagina to accept objects inside it.

Gradually this method helps the woman gain confidence that her vagina is big enough for sex. And she
should then soon be able to enjoy intercourse with her partner. Many counsellors and doctors like to
see the patient with her partner so that he can understand what is going on and encourage her.

What causes collision pains?

The soreness may be caused by infection, by a cyst on the ovary or be an enlarged uterus (womb).

It may also be caused by endometriosis.

You cannot diagnose the trouble yourself and should always see the doctor.

What causes pain at orgasm or some time after love making?

Pain at orgasm sometimes occurs during or after the menopause and is thought to be due to lack of
female hormones. It can be treated with HRT

based on a text by: Dr Erik Fangel Poulsen, Specialist