However, it’s not healthy if you always feel pain during intercourse. Of course, sexual discomfort is perfectly normal, especially when it’s a woman’s first time, says SmartParents expert and Gleneagles Hospital consultant ob-gyn Dr Christopher Chong.
He says, “It depends on how tense the couple is, how tight the vagina is and whether there is enough foreplay and lubrication. At most, you’ll experience some mild discomfort, nothing that will stop sex.”
However, if the pain continues or worsens, it could hint at something more serious. Of course, since painful sex means less enjoyable sex, so you won’t feel compelled to do the horizontal mambo as often as you’d like. This can throw a spanner in the works if you and your spouse are trying to conceive.
Both men and women can experience pain during sex. For men, reasons include a tight foreskin or swollen or bruised testicles. Here’s a list of health issues that could cause pain for women during intercourse.
“Sex causes friction between the penis and vagina. If the vagina is too dry, it can cause discomfort, pain and even abrasions and bleeding.”
1) Vaginal dryness
Medically known as atrophy, vaginal dryness is very common in menopausal women. However, it can also be caused by birth control pills, especially if the woman is taking those with a high progesterone level for an extended period, Dr Chong explains. Women who are nursing also experience it as breastfeeding results in a decline in oestrogen levels and causes vaginal dryness. “Sex causes friction between the penis and vagina. If the vagina is too dry, it can cause discomfort, pain and even abrasions and bleeding,” says Dr Chong. A dry vagina may not result in an orgasm ― devastating news for women in general. Worse, since an orgasm helps to “suck” in the sperm and propel it towards the uterus, your chances of conceiving will also be reduced.
TREATMENT OPTIONS Try lubricants, sex oils, and a revolutionary FDA-approved laser therapy called the MonaLisa Touch Laser Therapy. This treatment rejuvenates your vagina by delivering gentle laser energy to the vaginal tissue to generate new collagen and elastin, as well as improve the blood supply to the area.
2) Pelvic inflammatory disease
In this infection involving the genital organs, signs include abdominal pain during your menses, swollen, pus-filled fallopian tubes and a foul-smelling vaginal discharge. Pelvic inflammatory disease, usually the result of a sexually-transmitted infection, can be diagnosed through ultrasound scans or a swab test to check for bacteria. Fertility can be compromised because “it can cause scarring and blockage of the tubes, which will cause poor sperm transport,” Dr Chong note.
TREATMENT OPTIONS It’s a pretty straightforward condition to treat, usually with a course of antibiotics and symptomatic relief for the pain.
3) Retroverted uterus
Did you know the position of your uterus can influence how enjoyable sex can be? Dr Chong explains, “A retroverted uterus, or a womb tilting backwards, can put pressure on the woman’s back, which means sexual positions such as the missionary position can result in painful sex.”
TREATMENT OPTIONS Try a variety of sex positions until you find one that lets you both enjoy intercourse. Need some help? Check out our complete guide to the best sex positions for conception. Dr Chong also suggests sex-enhancing oils, longer foreplay, and oral medications to reduce pain or increase the sex drive, if necessary.
4) Vaginal agenesis
Vaginal agenesis is a rare birth defect that results in a partially-developed vagina. Occurring in less than 1 per cent of women in Singapore, it can also affect the rest of the reproductive tract, such as a much smaller or absent uterus. Not everyone who has this condition is aware of it ― the earliest age of detection is 16 ― so women who try to engage in sex experience a lot of pain. As the uterus is affected, your menstrual cycle will also be abnormal.
TREATMENT OPTIONS Surgery, also known as a vaginoplasty, is your best bet and you can start having sex as early as six weeks after that. The non-surgical route involves inserting a vaginal dilator to slowly create an opening where the vagina should be and supporting it with oestrogen hormones.
Endometriosis happens when the lining of the womb, also known as the endometrium cells, migrates over to other areas such as the ovaries and womb and sometimes even the bladder, intestines and nose. “About 20 per cent of women get it and it’s associated with heavy menses, painful periods and painful sex,” says Dr Chong. The condition is usually diagnosed through a biopsy of the cells or ultrasound scans. “It could cause scarring of the fallopian tubes or the lining of the womb which affects fertility,” notes Dr Chong. Endometriosis can also cause ovarian cysts, which can affect ovulation or result in an enlarged womb, which can affect implantation and pose a higher risk of miscarriage.
TREATMENT OPTIONS Medication for the pain or surgery to remove the excess tissue are your top treatment options. Hormonal treatments are also available, such as oral contraceptives and the Mirena IUD. Both contain progesterone to help with the condition but won't help if you’re trying to have a baby. Instead, adopt a healthy lifestyle and eat well as it can also help manage the condition. Read how one mum did just that and conceived!
6) Tight hymen
Difficulty in penetration, coupled with pain, are signs of a tight hymen. This means that it is usually thick and inflexible, and pain is felt when the penis pushes against it. Even if you manage to break the hymen, pain can still be felt during intercourse. Less than 1 per cent of women have this genetic disorder. Besides agonising sex, a tight hymen doesn’t affect fertility in any other way.
TREATMENT OPTIONS Surgery is your only option. “We can do a hymenoplasty, which will involve cutting off the hymen,” Dr Chong states.
“Pain during sex can affect your relationship and fertility, so don’t suffer in silence… The earlier the discovery and treatment, the better the results.”
Vulvodynia is chronic burning pain in the vulva, and sometimes, in the surrounding areas such as the clitoris. Dr Chong notes that these areas are sometimes also swollen. The pain ― the extent of which can differ ― occurs when the vagina comes into contact with something. So, activities such as intercourse, inserting a tampon, a gynaecological exam or even sitting down for too long can exacerbate it, according to the National Vulvodynia Association.
TREATMENT OPTIONS Since there’s no known cause for vulvodynia, doctors take a multi-disciplinary approach. Medication is given to alleviate the symptoms and Dr Chong recommends a psychiatric assessment, since the condition can affect a woman’s sexual relationship and emotional well-being.
Vaginismus is the involuntary tightening of the vagina walls which makes penetration difficult or close to impossible. You will feel a burning sensation when you try to have sex.
TREATMENT OPTIONS Both medication or surgery are good options to help widen the vagina walls, says Dr Chong. But there’s also a third option – talking to a counsellor, because sometimes, the “pain” can be related to the anxiety you’re feeling about having intercourse or even from a past traumatic sexual experience. By the way, if you and your spouse are game, there are also some DIY options. Sexologist Martha Lee suggests using dilators and vibrators to help you get aroused and prolong the sensation ― instead of anticipating pain.
9) Postpartum dyspareunia
According to the US National Library of Medicine, an estimated 50 to 60 per cent of women report dyspareunia ― pain during intercourse ― six to seven weeks following delivery. Up to 33 per cent of these women will still experience it three to six months later. Probable causes include vaginal tears, an episiotomy and damage to the pelvic floor muscles.
TREATMENT OPTIONS Lubrication and sex oils can be used to help things along if the scarring is causing the problem, as can relaxation techniques. Otherwise, pelvic floor physiotherapy can be performed to strengthen the pelvic-floor muscles and ease the pain.
If you’re experiencing any of the above-mentioned issues, don’t be shy ― speak to your doctor at once. Everything will be kept strictly confidential. “Pain during sex can affect your relationship and fertility, so don’t suffer in silence,” says Dr Chong. “There are ways to help and if it is due to any growths or medical condition that needs treatment, the earlier the discovery and treatment, the better the results.”
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