Reclaiming Intimacy: Painful Sex

Sexual intercourse is a natural part of life; the only way we can reproduce, and our world can keep turning. There are many ways to go about having sex as there is no real “right” way. There are, however, certain things that should not be happening during sex, and if they are, you should check in to the issue. If you are experiencing pain during intercourse, or even foreplay, you should know that that is not a common side effect of sex. Another commonly used term for painful sex is sexual dysfunction, or dyspareunia. Dyspareunia is defined as constant, or recurrent genital pain that occurs just before, during, or after intercourse. This can occur for any reason, at any age, causes ranging from structural problems to psychological and mental constraints.

The symptoms, while personal, can feel quite loud and prominent in our daily lives. The top symptoms listed are:
– pain only at sexual penetration or entry
– pain with every penetration, which could also include inserting tampons for women
– deep pain during thrusting
– burning or aching or stabbing pain
– throbbing pain, lasting hours after intercourse

Sex can be painful for both men and women. More often than not, the majority of complaints about painful sex came from women at different stages of their lives. Men can experience pain during sexual intercourse as well, for many of the exact same reasons.

Common Causes of Painful Sex

Entry Pain

Pain during penetration could be present for a number of reasons. The following reasons are some of the top reported causes of pain during sex among adults. Many of these can be said for men or women when it comes to pain.

– Not enough lubrication. While this can simply be from lack of foreplay, many people experience severe vaginal dryness from many different causes. A drop in estrogen levels after menopause or childbirth, or even during breastfeeding could be the reason. Not using enough lubrication during sex can cause men to have pulled and torn penial tissues, which can end with a great deal of pain.
– Injury, trauma or irritation. Pelvic surgery, skin tears, accident or trauma could make already sensitive tissues even more so.
– Infection, inflammation, or certain skin disorders can cause painful intercourse. Some infections can be seen with the naked eye and have symptoms and side effects that make themselves known. Other types of infections or inflammation is not always as prominent, and often help doctors diagnose whatever is causing the pain with more focused results.
– Vaginismus (in women) causes involuntary spasms in the vaginal canal. These spasms can make sex difficult and painful.
– Congenital abnormalities are problems that are present from birth. This could range from complete defects to missing appendages, even misfiring nerve endings.

Emotional Factors

There are a number of mental factors that have a role in determining how painful, or pleasant, sex will be. Some of these psychological issues include anxiety, depression, lack of self-confidence, fear of intimacy, relationship troubles, or your own personal dislike of yourself or looks can contribute, resulting in discomfort and pain during the act.

Stress is a huge factor in our ability to relax and focus in the moment, and it can also keep our bodies wound up tight, ready for a fight and unable to relax into orgasm. Another factor for many humans, male and female, is sexual trauma and the mental anguish that follows. It can be hard to tell if your sexual pain is caused by something mental or physical. If you suspect you are having difficulty mentally, see your primary care physician for a proper referral.

Just for the Women

There are certain conditions, some unexplained, that affect women and the function of the vagina. On top of the things listed above, other conditions such as urinary tract infections, yeast infections, and sexually transmitted diseases can hinder the pleasure of sex and make it quite miserable. Not only does pregnancy and breastfeeding alter how our bodies achieve pleasure, the internal healing can also change how the vagina and canal are shaped, feel, and function. For women who had a vaginal tear during childbirth, the scar tissue that builds to heal the skin can tighten too much, making any penetration reminiscent of the birth itself. Endometriosis can also cause great pain around the entire abdomen. Endometriosis is a condition where the cells that usually line the uterus (endometrium) grow outside of the uterus on other organs, fallopian tubes, ovaries and more. This is a very painful condition with a myriad of its own side effects and issues that affect women entirely. The good news is that most all issues that cause sexual pain and discomfort can be treated and the pain relieved.

When to Consult a Physician

Any pain related to sexual intercourse is best handled first by your primary care physician or urologist. For women, your gynecologist can also be called. Depending on the underlying causes of the pain, other specialists like psychologists, psychiatrist, or specific urologist might need a referral. While pain during intercourse is not usually an emergency, there are certain things that could warrant an emergent doctor visit. Those things are:

-sudden onset pain with bleeding or severe cramping, lasting longer than a few minutes

-bleeding following pain, particularly severe sudden onset pain

-Nausea, vomiting, or rectal pain after intercourse

-a new, abnormal discharge

What Can I Expect from the Doctor

The doctor, nurse or physician’s assistant will begin by taking your history and having you describe the pain or issue. If there are visible signs of this ailment or pain, you would now show the doctor.

For men, this would mean a penile examination, which means the doctor will palpitate and visually check your penis and testicles. This might also mean a DRE procedure, which takes moments and is only mildly uncomfortable. Upon the results of these tests, you will then discuss further treatment, tests, or specialist needs.

For women, this might mean a full pelvic exam, where the doctor uses a scope to open the vaginal canal to get a clearer view of the internal mechanisms of the vagina. This exam might also include a rectal or rectovaginal exam as well. While this can be mildly uncomfortable, it is a quick and important part of the testing. Biopsies, bacterial and fungal testing swabs, and any additional tests can be done at that time or ordered for the future. Most often, tests like a CT scan, MRI or cystoscopy are also ordered if the pain persists or is unidentifiable. Results from those tests will determine if medication, intervention, or other type of treatment is needed.

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