Dr. Sharath Kumar

Painful or difficult intercourse is either caused by psychological or medical factors, such as dyspareunia. It is commonly known as painful intercourse due to various reasons and persistant pain in the pelvis region is a sign of it.

What an cause dyspareunia?
The causes of dyspareunia can vary, depending on when the pain occurs; during deep thrusting or penetration. Sometimes, emotional factors contribute to the cause as well.
1. Entry pain
Pain during penetration may be caused by the following factors:

• Insufficient lubrication: Inadequate foreplay can result in insufficient lubrication. Breast-feeding, menopause or childbirth can also cause inadequate lubrication.
• Irritation, trauma or injury: This includes irritation or injury from pelvic surgery, an accident, female circumcision or episiotomy (incision made at the time of childbirth to expand the birth canal).
• Skin disorder, infection or inflammation: Infections in the urinary tract or genital organs can result in painful intercourse. Skin problems such as eczema can also add to dyspareunia.
• Vaginismus: Uncontrollable vaginal wall muscle spasms can make penetration extremely painful.
• Congenital abnormality: Problems during birth, such as lack of a fully-developed vagina or underdevelopment of the hymen are some underlying causes.

2. Deep pain
Deep thrusting can be attributed to the following causes:

• Certain conditions and illnesses: These include ovarian cysts, haemorrhoids, irritable bowel syndrome, cystitis, uterine fibroids (benign growths in the uterus), retroverted uterus (uterus that is tilted), uterine prolapse (a condition characterized by the uterus sagging from its usual position), pelvic inflammatory disease and endometriosis (uterus lining tissues growing outside one’s uterus).
• Medical treatment or surgeries: Medical treatments such as chemotherapy and radiation or surgeries like hysterectomy (a surgical technique to remove either a part or whole of the womb) can result in dyspareunia.

3. Emotional factors

• Psychological problems: Depression, anxiety, body image issues, relationship problems or intimacy fears can affect arousal and result in pain.
• Stress: Pelvic floor muscles are affected by stress. This contributes to pain during sex.
• Past sexual abuse: Dyspareunia commonly develops in women who have been abused in the past.

The symptoms of painful intercourse include:
1. Pain only during entry (Sexual penetration)
2. Any penetrative activity is painful; even inserting a tampon becomes painful
3. Sudden sensation of pain, especially if sex before was painless
4. Deep pain while thrusting
5. Aching or burning pain
6. Throbbing pain, persisting hours after sex