painful sex
Painful sex (medical term: dyspareunia) can occur at any point in a patient’s sexual life and can have multiple different causes. Your doctor will want to know if the pain occurs with every act of intercourse, if you have ever been able to have sex without pain, if the pain is deep in the vagina or more superficial near the entrance, how you would describe the pain (sharp, crampy, friction, tearing/splitting etc.), if there are any associated symptoms such as abnormal bleeding or discharge and if the pain gets better or worse after intercourse.
Potential causes include vaginal, cervical or pelvic infections, pelvic masses, gynecologic disorders such as endometriosis and adenomyosis, vaginal dryness associated with decreased estrogen levels (often noted in perimenopause, menopause and breast feeding post partum patients), vulvar skin conditions (lichen sclerosis, lichen planus, psoriasis etc.), vaginal muscle spasms (medical term: vaginismus) and vulvar nerve pain disorders (medical term: vulvodynia).
You doctor will need to perform a pelvic examination, which will include assessing the vulvar anatomy, assessing the vulvar entrance for sensitive nerve endings, palpating the vaginal muscle tone, palpating the cervix, uterus and ovaries for tenderness and masses, and looking at the vagina and cervix with a speculum. Depending on your symptoms and the exam findings, your doctor may want to do some swabs for infection and possibly order a pelvic ultrasound.
One of the most common causes of painful sex is vulvodynia. In this condition certain nerves of the vulva have become hypersensitive and create a pain response when touched. Often the hypersensitive nerve endings are found in the vestibule, which is the entrance of the vagina. Many people with this condition also have vaginismus as the vaginal muscles spasm in response to the pain caused by touch. Many patients will describe any insertion into the vagina as painful (tearing, burning, sandpaper, dry etc.) and also may describe feeling like there is a “wall in their vagina” which is actually the muscle spasm occurring.
Depending on the cause of the dyspareunia, many different treatments may be considered. Unfortunately, some diagnoses such as endometriosis and vulvodynia are chronic conditions and although they can be improved, they can never be fully cured. Knowing this is actually a very important part of understanding how to manage the condition moving forwards. Often with the chronic conditions, your doctor may recommend working with many different care providers to help treat the condition, including pelvic floor physiotherapists and sexual medicine physicians/counsellors.