After the first few times, sex shouldn’t be painful. Pain during intercourse can cause emotional problems and seriously affect your relationship, so getting it sorted out should be a priority. Whether it’s caused by gynaecological, urinary, vascular, dermatological or psychological reasons, it can get worse over time as you lose your confidence and anticipate pain.
Identifying the cause
Before you head to your GP, think about the way the pain manifests. If you can, pinpoint when it began. Has it always been there, is it with a particular partner or did it begin after an event such as an infection or operation or perhaps after childbirth. Also try to work out where exactly the pain is – is it deep pain or irritation around the entrance to your vagina?
- Check the skin around the area for any scars or changes to the skin’s surface. Use your finger to detect the painful spot or to see if any muscles seem too tense or contracted.
- Do you have any other symptoms, such as burning, itching or discharge?
- Do you notice if the pain is connected to your cycle or whether it gets worse at particular times of the month
- Do sex or particular sexual positions affect the pain?
- How long does the pain last when it flares up?
[Related story: Staying happy in a long-term relationship]
Pain at penetration
This could be an infection, including STIs, thrush or cystitis. Or it could be dermatological (such as eczema)or anatomical (related to any operations or childbirth). In rare cases your hymen or ligaments in the vagina may be too tight and need medical treatment.
This is more likely to be a symptom of a medical condition including uterine fibromas, ovarian cysts, endometriosis, or even cancer. If you have deep vaginal or pelvic pain, head straight to the doctor.
Constant irritation or pain
If you’ve ruled out the other problems, you may have a case of generic vulvodynia. Literally, this is simply a ‘painful vulva’ and there are no physical symptoms for doctors to diagnose. It’s more of a case of ruling out everything else. No one’s totally sure what causes it but it’s thought that around 15 percent of women experience it at some point in their lives. You may need a referral for treatment in this case so if your problem isn’t clearing up with numbing creams, make sure you return to the doctor for further treatment.
Psychological causes of painful sex
If you’re tense or nervous, your body will tense up too preventing lubrication and the muscles relaxing. Worrying about it hurting then makes it worse and you may find yourself in a vicious cycle. Addressing the reasons for your anxiety, such as fear of disease or being unsure about your partner, may help. But pain doesn’t necessarily mean there’s anything wrong with your relationship or your feelings for your partner. The cause can be less obvious or even subconscious, in which case you may find it useful to visit a sex therapist.