When sex hurts (Part 1)
Dyspareunia (“dis-par-oon-ya”) is painful sex, due to medical or psychological reasons. It is used mostly to describe women, although men can also suffer pain during sexual contact. Most of the time, the cause can be reversed, even when long-standing, but for some, it may be a recurrent ordeal. When pain occurs, the woman experiencing dyspareunia may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease and she may begin to have a negative association with sex just anticipating the pain
What are the causes?
Pain during sex may happen in any part of the genitals. It is important to differentiate whether the pain happens upon penetration or on deep penetration or if it happens way after intercourse is over, because the causes may be entirely different.
Superficial dyspareunia is pain upon entry. The pain from these conditions is usually felt when a tampon or penis is inserted into the vagina. Sometimes, even sitting or wearing pants can cause discomfort. The most common cause of painful entry is a lack of foreplay where the woman has not been “warmed up” by her partner and has, therefore, not been lubricated well enough. A man can reach his orgasm in 2 minutes but for a woman, it is prudent to spend at least 20 minutes on foreplay and insure the female genitals are well-flooded before entry begins. In pre-menopausal or menopausal women, this can be real concern because when estrogen wanes during this time of the woman’s life, the vulvar and vaginal skin thins out, dries out, and produces less lubrication which comes from transudation through the vaginal skin.
Dermatologic conditions can also cause pain upon entry. Sometimes it can be caused by something as simple as using soap to wash the external genitals or using the wrong vaginal wash. Frequent douching or washing especially with soaps or the wrong vaginal wash can kill the good bacteria or cause allergies from the chemicals used. Most soaps (even the mildest such as baby soap) have a pH of 7 and above, meaning it has an alkaline ph. That is appropriate to cleanse the skin of the rest of the body but the female genitals need to maintain a pH of 3.5 to 5.5 to keep alive the protective bacteria, the lactobacilli, and doing their job of protecting you from fungal and bacterial infections. Tipping off the pH can make you prone to yeast infections or to bacterial vaginosis which can manifest with a discharge, a foul smell (more typical with bacterial vaginosis described as “fishy odor”) and skin irritation. This is the reason vaginal washes were produced to keep the vagina at the appropriate pH. However, not all vaginal washes are created alike. Some are more irritating than others because of the chemicals used to disinfect, color or perfume the solution. It is best to stick to lactic acid-based washes.
A viral infection such as herpes can also produce painful sores on the genitals, both for males and females that can be transmitted to an uninfected partner, aside from increasing your predisposition to fungal infections. An infection of the bartholin’s gland at the opening of the vaginal may produce a swelling or inflammation that may make entry during sex painful. A scar tissue from a previous episiotomy (cut on the perineum during a normal birth) can also cause pain during intercourse.
Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia (medical term meaning chronic vulvar discomfort e.g. burning, stinging, irritation, rawness). affecting premenopausal women. It tends to be associated with a highly localized “burning” or “cutting” type of pain. The woman senses the irritation and burning which can be felt hours or days after sex, giving one a sense of hopelessness and depression.
The prevalence of VVS is quite high: affecting 10 percent to 15 percent of women seeking gynecological care. You can feel severe pain at the opening of the vagina with attempted penetration and after penetration you become sore and tender with pressure. Your doctor can apply the cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. The causes may include a subclinical human papillomavirus infection, chronic recurrent candidiasis, or chronic recurrent bacterial vaginosis or it could result from chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some researchers even believe there is a neurological cause to it relating to thickened changes of the nerves. Finally, psychological factors may even worsen the problem, because the moment you think or desire sex upon arousal, it causes you to anticipate the pain, thus resulting in a conditioned spasmodic reflex . Problems with your spouse then emerge with chronic frustration, disappointment, and depression along with it.
Deep dyspareunia is pain on deep penetration or deep thrusting can be caused by a chronic pelvic inflammatory disease such as gonorrhea or Chlamydia or by endometriosis (condition where the lining of the uterus implants outside the uterus so everytime you menstruate, you bleed into the abdominal cavity). Pelvic masses such as myomas or ovarian cysts can also cause pain.
Vaginismus (“vag-in-is-mus”) is a spasm of the muscles around the vagina, sometimes so severe that penile penetration is impossible. Causes can be from past sexual abuse, painful first sexual intercourse or gynecologic examination, religious brainwashing to think that sex is “bad or dirty” or a misconception in the size of the vagina, an unopened hymen (yes, anatomic defect where there is no hole), chronic infection like gonorrhea or Chlamydia.
Interstitial Cystitis (IC). is now a recognized cause of dyspareunia. It is a condition where patients may struggle with bladder pain and discomfort during or after sex. For women with IC, pain usually occurs the following day, the result of painful, spasmodic contractions of the pelvic floor muscles. Men are not spared from this condition since pain occurs at the moment of ejaculation and is focused at the tip of the penis. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency.
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Dr. Rebecca B. Singson holds clinic at Makati Medical Center, 892-7879 or 888-8999 local 2381 and at Asian Hospital & Medical Center, 771 9204 or e-mail mailto:obmd@surfshop.net.ph.
