Pain During Intercourse

This problem is so emotional and sensitive that many woman find it difficult to consult a physician. But it's important to seek treatment, and in many cases the cause is a physical illness that can be treated.

Painful intercourse, which a doctor may call dyspareunia, is a burning, tearing, ripping, or aching sensation associated with penetration. The pain can be at the vaginal opening, deep in the pelvis, or anywhere in between. It also may be felt throughout the entire pelvic area and the sexual organs, and may occur only with deep thrusting.

The most common explanation is irritation of the vagina caused by having intercourse without sufficient arousal and lubrication. This experience can create a vicious circle, leading a woman to fear intercourse which in turn makes it more difficult to become aroused. Women who have had a hysterectomy or mastectomy may have problems with arousal because of feelings of incompleteness. Stress or problems in your relationship with a partner can also block arousal. Counseling can help address these psychological issues, and over-the-counter lubricants (consult your doctor or pharmacist) can increase lubrication and reduce discomfort.

Another frequent explanation for painful intercourse is thinning and drying of the vaginal tissue as menopause begins. This happens because the body is producing less and less of the estrogen that is needed to maintain moist vaginal tissue. As the vagina's ability to make its own mucus declines, it becomes dry, itchy, and painful, leading to discomfort during intercourse. Estrogen creams and lubricating gels can help restore moisture, as can estrogen replacement therapy taken in pills or through a patch on the body.

Unintentional muscle spasms of the thighs, pelvis, and vagina can make penetration impossible. This condition, called vaginismus, can develop along with any of the other causes of painful intercourse described here or can result from psychological factors. A traumatic sexual experience, rape, or an irrational fear of genital injury can lead to vaginismus. Counseling can be helpful.

Other causes of painful intercourse include:

• Infection—vaginal, pelvic, herpes, infected cysts or boils

• Scars, tumors, or anything that narrows the vagina

• Endometriosis (uterine tissue growing outside the uterus with bleeding, pain and scarring)

• Intact hymen (in virginal young women)

• Complications of surgery

• Diseases that interfere with the physical process of arousal or orgasm (such as diabetes and multiple sclerosis)