Painful sex (or dyspareunia or vulvodynia in official terms) is one of the most common sexual problems in women. The pain is often described as a sharp, stinging pain at the entrance of the vagina when attempting to have intercourse. This sensation of pain can last throughout the full duration of penetration or can disappear after a while. Some women describe the pain as deep and dull which is usually experienced deeper within the body/belly. These two different sensations of pain can coincide or can be experienced separately. The causes of these two types of pain (superficial/deep) can be different so it's important to distinguish them. Both can have a negative impact on the enjoyment of sexual interaction which could result in stress within your intimate relationship.
Painful sex could also be referred to as vaginismus. This describes involuntary spasm or contraction of your pelvic floor muscle group which can inhibit entrance to the vagina by a finger, tampon or penis. Vaginismus can make penetration or even the use of tampons impossible or very painful. Some women describe the sensation when trying as 'hitting a brick wall'. Some women just experience problems with intercourse, others describe the same reaction when using tampons or during a physical examination by a medical professional. The pain experienced when attempting intercourse can cause severe stress in the relationship, strong feelings of dissatisfaction or worthlessness. Vaginismus can start at the first sexual experience or later in life. It is usually unrelated to sexual trauma in contrast to what is often assumed.
Causes of pain
The causes of feeling pain during intercourse can be divided into physical and psychological factors. The physiological causes can be (not exhaustive): infections, thrush, STI, skin problems, genital malfunction, medication, menopause and endometriosis. The psychological causes can be related to these physical causes. Most women with pain during intercourse have developed some tension or anxiety towards the pain experience and expect the pain to appear again which negatively impacts their levels of arousal and desire. This could eventually result in a negative vicious cycle which we describe as the 'pain cycle'.
Other common factors that contribute to the development of pain can be (but are not restricted to) lack of knowledge or experience, anxiety, lack of self-esteem, restrictive/religious beliefs, negative expectations, feelings of unsafety, or fear of pregnancy.
In Selma's practice, the treatment of pain during intercourse will start with a thorough assessment of the pain experiences to discover possible causes and discuss best practice treatment options to eliminate the pain experiences by replacing them with positive and pleasant sexual experiences. This could be realised by the use of relaxation and pelvic floor exercises, discovering positive factors impacting on your arousal levels, stress management, changing negative thought patterns and communication with your partner about excitement and arousal inducing behaviours. When women are experiencing difficulties in gaining control over the tension in their pelvic floor area, a referral to a pelvic floor physiotherapist could be helpful. This treatment is usually most effective when coinciding with Sex Therapy.
If you would like to start your treatment for your sexual pain problem click here to contact Selma van Diest.