Definition

    
Pain in the pelvis or vagina experienced during vaginal penetration, sexual intercourse or after sex.

Alternative Name

• Dyspareunia

Common causes of intercourse pain may be linked to:

• Poor communication between partners
• Daily stress
• Physical conditions (like pregnancy)
• Menopause
• Medication use (birth control pills and mood stabilizers)
• Illness (vaginal infections or endometriosis)
• History of sexual assault

Pain that starts deep inside (near the cervix) may be a warning sign of an internal problem that may include:

• Pelvic Inflammatory Disease
• Infection
• Problems with the uterus
• Endometriosis
• Scar Tissue
• Ovarian Cysts

What is Sexual Health?

      
During sex a woman may feel pain in the vulva, at the opening of the vagina, within the vagina or deep inside. Vulvar pain is pain felt on the surface (outside) of the vagina at the vulva, or labia. Vaginal pain is felt within the vagina. Deep pain can occur in the lower back, pelvis, uterus and bladder. Different types of pain have different causes. It’s important to identify the location of the pain, so the doctor can detect the cause and properly treat it.

Talking between partners is the first step towards a healthy sex life. If a woman enjoys the relationship, the greater the desire is to have sex. Conflicts can make it hard to have or enjoy sex. Poor communication is the most common reason for decreased libido and decreased sexual enjoyment. Improving communication between partners, including seeking couples counseling, can significantly improve sexual libido and sexual satisfaction.

Sexual responses are individualized and vary from woman to woman. If a stage of the sexual response cycle doesn’t occur, it may cause a sexual problem. A woman’s body typically follows a regular pattern when she has sex. The four stages of sexual response are:

• Desire- Feeling of wanting to have sex. Sexual desire includes the drive and motivation to have sex. This is the most common sexual problem in women.
• Arousal- Physical changes in the body to prepare for sex. The vagina and vulva get moist and the muscles of the opening of the vagina relax. The clitoris swells and enlarges.
• Orgasm- Peak of sexual response. The muscles of the vagina and uterus contract and create a strong feeling of pleasure. The clitoris can feel orgasm, too.
• Resolution- The vagina, clitoris, and the uterus return to their normal state.

It is common for sexual desire to decrease during menopause. In menopause, the decreased levels of estrogen can make the vagina dry and thin, and shrink vaginal tissues. There is also a decreased amount of nerve sensation in the genitals. As women age, they may lose desire slowly, have a hard time getting aroused and feel discomfort with sex.

A woman’s sexual response peaks in her late 30s and early 40s in most cases. However, almost all couples have a problem with sex at some time in their lives. The most common cause of sexual pain is that the vagina is not well lubricated. Vaginal dryness can occurs when women are not aroused enough during sex, or there are physical changes in a woman’s body that prevents adequate lubrication. Often it is helpful for a couple to use a water-based cream or jelly to provide vaginal lubrication.

How WomanCare Can Help

      
Sexual health is a complicated and personal issue for many women, and questions regarding sexual activity and sexuality can be hard to ask. WomanCare Clinic offers sensitive counseling and one hour appointments to address sexuality and sexual activity issues. Our goal is to help determine the cause of sexual dissatisfaction, and to offer resources and therapies that improve sexual functioning and satisfaction. We will review your past medical history, current medications, menopausal status, and quality of life issues, including your current relationship.