Guest Post: Painful Sexual Intercourse

Dyspareunia (dys*pa*reu*nia) means painful sexual intercourse.  The pain can occur with initial penile penetration, and/or during thrusting, and may even be there after intercourse (an after-effect).

What are the causes of painful sex (dyspareunia)? There are quite a few, including

• Medical causes, such as vaginal infections, sexually transmitted infections, skin conditions (dermatoses), hormonal problems, conditions of the intestines or genitals or urinary system;
• Physical causes, such as vaginal abrasions, scars, nerve damage, complications from vaginal delivery, size incompatibility;
• Functional causes, such as genital irritation due to excessive hygiene or sensitivity to cleansing agents, poor hygiene, friction irritation, insufficient vaginal lubrication;
• Psychophysical causes, such as vaginismus, postpartum crisis, interpersonal difficulties, forced sexual encounters;
• Menopause
• Cancer
• Sjogren’s Syndrome

Naturally, when intercourse is painful, the woman will want to avoid the act. Furthermore, she may also decline outercourse (non-penetrative sex, such as oral or manual) because she does not want to be reminded of the pain, or of disappointing the partner, or because she is worried  that he will sneak into her vagina. Another major avoidance is being totally shutdown sexually – a common coping mechanism of women that does not take much to develop.

From a psychophysical point of view, let us be reminded that intercourse is about the penis entering the woman’s body — being the ‘do-er’ to her being ‘done to’ — and, therefore, it has to be invited and welcomed into her vagina when her body and mind are in sexual balance

Painful sexual intercourse (dyspareunia) is a source of great conflict and anxiety to the woman who suffers from it, causing marked distress and interpersonal difficulties. Although intercourse is possible, the accompanying pain triggers negative attitude toward sexuality, sexual function impairment, and lower levels of sexual adjustment. 

Unfortunately, women often put up with painful intercourse, depriving themselves of healthy intimacy, which should be the cornerstone of any relationship.  Women rarely seek medical assistance to discuss sexual difficulties, a fact that makes it impossible to assess the prevalence of dyspareunia.  The two main reasons behind this reluctance are women’s tendency to accept pain as an inevitable part of intercourse, and their worry that the clinician will ridicule them or dismiss their complaints as “being crazy.”

On the other hand, the sad truth is that not all clinicians are attuned to the nature or presence of this condition, nor are they comfortable discussing such intimate matters.  Although there have been gains in this direction in recent years, taking a thorough, detailed sexual history at the time of doctor’s visit is still not the standard of care.

It is very important for the couple to hold a candid discussion about the situation. The man will need to promise NOT to attempt any vaginal penetration (finger and/or penis) while the woman is being encouraged to enjoy herself as much as she can without pressure to orgasm — let it happen if/when it does. Make it fun, friendly, and stress-free!

The goal is to maintain an agreed-upon style of comfortable sexual intimacy and avoid slipping into asexual existence, or living like ‘brother and sister,’ which will put quite a bit of pressure on the relationship.

Lastly, sexual counseling may be of great value in order to resolve underlying causes for this sexual breakdown, and to guide the couple onto a positive intimate journey.

written by:

Dr. Ditza Katz, PT, PhD, Women’s Therapy Center, Plainview NY