Superficial Intercourse Pain

Intercourse pain, also known as dyspareunia, is the experience of pain in the pelvic area during and immediately after sex.

Dyspareunia might be quite common but it is unknown exactly how many women suffer from it as many women simply do not report it.  Surveys suggest that anywhere between 1 and 4 in 10 women experience intercourse pain of some kind.

It is important to consult your doctor early on.  Unchecked dyspareunia can lead to sexual nervousness, causing dryness which can lead to further pain.

Superficial intercourse pain describes pain in the vulva, at the vaginal entrance (introitus) and the outer part of the vagina.

Superficial intercourse pain can at times occur in conjunction with deep intercourse pain.

Causes of superficial intercourse pain include:

  • Intact hymen
  • Scar Tissue

Vaginismus:

Vaginismus is a powerful and often painful contraction of the muscles around the entrance to the vagina (the pubococcygeal muscles). This spasm is involuntary and may begin for no reason, but can also result from a worrying or painful experience of sex and continue as a protective reflex.

Bartholinitis:

Inflammation of the Bartholin’s glands, a pair of glands in the tissues of the vaginal wall, which can lead to tenderness and pain during intercourse.

Vulvar vestibulitis:

A condition where the vulval area becomes painful and extremely sensitive to pressure and touch. This can lead to superficial pain upon attempted penetration.

Lichen sclerosus:

A scarring skin condition which results in thinning of the skin of the genital area, together with formation of white patches.

Female genital mutilation:

Also referred to as female circumcision, involves varying degrees of mutilating surgery to the external genitalia. In the most extreme form, the vagina is stitched shut. This can result in permanent scarring and cause pain during intercourse.

Vaginal abnormalities:

Rare abnormalities can make sex painful or impossible. This could include pieces of extra tissue inside the vagina (vaginal septa).

 

Some causes of superficial intercourse pain that may also lead to deep intercourse pain include:

Vaginal tears

Vaginal or genital infection:

Infections caused by thrush, herpes, or bacteria can result in inflammation. In such cases the vagina can remain sore and itchy even after sex. Coloured discharge and offensive smells are other signs of vaginal infection.

Vaginal dryness:

Lack of lubrication can be a cause of intercourse pain. The vagina produces secretions upon arousal as a natural lubricant. Dryness can be a result of insufficient foreplay. However dryness can also: have psychological causes, be triggered by menopause, be drug related, be caused by Sjögren’s syndrome or rheumatoid arthritis, or be tied to pregnancy or breastfeeding.

Vaginal atrophy:

Levels of oestrogen, the hormone that keeps the vaginal wall strong and resistant, drop following menopause. This leads to a thinner, less stretchy and poorly lubricated vagina which can result in painful intercourse.

Factors such as age, as dyspareunia is more commonly found in post-menopausal women, and whether or not you have given birth vaginally can increase the likelihood that you will experience superficial intercourse pain.

Risk is also increased by not practicing safe sex as this could lead to a sexually transmitted infection.

It is important to know the exact location, length and timing of the intercourse pain, and it is vital perform a physical examination to find the underlying cause.  Other questions a doctor might ask include:

  • Was there a time when intercourse was painless?
  • Are symptoms improved by using artificial lubricants?
  • Are you at risk for sexually transmitted infections?
  • Have you ever been sexually abused, or had a traumatic injury involving your genitals?

In addition:

  • If you are middle-aged – are you experiencing irregular periods, hot flashes or vaginal dryness?
  • If you are a new mother – are you are breastfeeding?

The physical examination will reveal signs of dryness on the vaginal wall, inflammation, infection, genital warts or scarring.

Treatment depends on the cause of the superficial intercourse pain. Some treatments include:

  • Vaginal dryness can be alleviated with artificial lubricants.
  • Vaginal thrush is treated with anti-fungal medication.
  • Oestrogen cream may also be used to help with vaginal atrophy if contraindicated.
  • The MonaLisa Touch laser, a fractional CO2 laser, can revitalise atrophic vagina, and help decrease superficial intercourse pain.
  • Antibiotics are utilised to treat any infection
  • Pain can often be relived by taking a warm bath in a sitting position
  • Long standing intercourse pain with no obvious cause may need psychological counselling. This will address stress or anxiety related to sexual intercourse.