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When sex hurts

Many women suffer pain during intercourse - known as dyspareunia - at some point. For most, it's a passing discomfort. But for some, pain becomes a regular feature of love-making. Psychosexual therapist Paula Hall looks at the possible causes and solutions.

In this article
Lack of sexual arousal
The pain cycle Self-help techniques
Check with your GP Further reading

Lack of sexual arousal
This is by far the most common cause of painful intercourse. When a women's body is ready for sex, the vagina expands both lengthways and widthways. While this is happening, your vagina becomes moist and lubricated to avoid any friction. The vagina wasn't designed to be penetrated in its unaroused state.

If you're sure you're fully aroused but still suffer from pain, check with your GP that you aren't suffering from an underlying condition.

The pain cycle
The problem with pain is that it blocks sexual arousal. And of course, lack of arousal causes further pain.

Many women find that they're caught up in a pain cycle. Having already experienced painful intercourse before, they fear more pain. The fear of pain blocks arousal, the lack of arousal causes more pain and so the cycle continues.


The Eros device
There's a nifty new device on the market that claims to increase blood flow to the clitoris and therefore improve sensation and lubrication. The Eros device is an electronic vacuum pump that you use at home - similar to the pumps that have been used by men for years to improve erection. See your GP or psychosexual therapist for more details.


Self-help techniques
For ways to put these tips into action, see the section on practical exercises.

Relax. This is the most important thing you can do. Have a bath, use deep-breathing techniques or buy a relaxation tape from your local health shop.
Work on relationship issues. You need to be sure that your head and heart are in the mood for sex as well as your body. If you're unhappy about something with your partner then sort it out first.
Exercise your pelvic floor. This will increase the blood flow to your genital area and make you more conscious of any sensations of physical arousal.
Try using fantasy. Get yourself in the mood by slipping into a favourite fantasy.
Enjoy being sensual before you're sexual. Take your time and let your body really focus on the pleasurable sensations of touch.
Lubricate. It's hard to stimulate a dry clitoris. Use lubrication to speed up the process; keep a tube by the bed.
Stimulate your sympathetic nervous system. Exercise, watch a scary movie, go on a roller coaster - in fact, do anything that will speed up your heart rate. Research suggests that your body will be more sexually responsive 15 to 30 minutes later.
Check with your GP
Don't worry if none of the self-help techniques work for you. It's likely that whatever is causing the pain is treatable once appropriate help has been found. You might want to ask your GP for advice or seeing a psychosexual therapist.

If you've been suffering from painful intercourse for a while, it's essential to check that you're not suffering from an underlying condition. Your GP will probably ask you some of the following:

Is the pain just around the outside of your vagina or is it deeper?
Is the pain to one side or both?
Do you have any back pain?
How would you describe the pain? Is it a deep ache, or sore and burning, or sharp and stabbing?
Do you only feel the pain during intercourse or does the pain persist?
Does it vary at different times of the month or in different positions?
If the pain is in your lower abdomen or to one side, you should see your GP to rule out any gynaecological disorder eg endometriosis, prolapse, ovarian cysts, fibroids and pelvic inflammatory disease.

Another possible cause is uterine retroversion, a natural condition where the womb tilts towards the back of the pelvis. In all these conditions, you may find that a different position, where thrusting is not so deep, is more comfortable. If you experience ongoing vulval discomfort then you should check with your GP to see if you may be suffering from vulvodynia or vulval vestibulitus. You can get more information on these conditions from the Vulva pain society


Temporary coauses

Childbirth. It's quite common for women to suffer some discomfort after childbirth, particularly if there was an episiotomy - a cut to make delivery easier.
The menopause. Intercourse may be more painful during the menopause as lower oestrogen levels cause a thinning of the vaginal wall. Ask your GP or local menopause clinic about oestrogen cream, which usually resolves the problem quite quickly.
Urinary infections. Cystitis or vaginal irritations such as thrush, vaginitis, and genital warts are also likely to cause soreness. Once the underlying condition has been diagnosed, a course of treatment should solve the problem.
Sensitivity to condoms. You may be irritated by certain makes of condoms, contraceptive creams or lubricants. Experiment with different makes.
 

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