- Superficial dyspareunia: Pain only at the time of penetration
- Pain with coitus, even when putting in a tampon
- Pain with certain partners or just under certain circumstances
- New pain after previously pain free intercourse
- Deep pain during thrusting, often described as a stabbing pain
- Burning pain or aching after intercourse
- Not enough foreplay
- Drop in oestrogen levels after menopause, after childbirth or during breast feeding
- Certain medications inhibit desire or arousal such as anti depressants, high blood pressure medications, sedatives, antihistamines and some birth control pills
Injury, trauma or irritation:
- Injury or irritation from an accident
- Pelvic surgery
- Female circumcision
- Congenital abnormality
- Inflammation, infection or skin disorder
- Vaginismus: Involuntary spasms of the muscles of the vaginal wall which often can be a protective method to avoid pain
- Deep pain: Occurs with deep penetration and may be more pronounced with certain positions
- Pathological causes such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis, irritable bowel syndrome and ovarian cysts.
- Surgeries or medical treatments: Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes cause painful intercourse. Medical treatments, such as radiation and chemotherapy, can cause changes that make sex painful.
- Emotional factors, sexual abuse and psychological problems
- Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationships problems can contribute to a low level of arousal and a resulting discomfort or pain.
- Stress: Pelvic floor muscles tend to tighten in response to stress in life. This can contribute to pain.
A thorough Medical history, pelvic examination, vaginal swabs, pap smear and pelvic ultrasound +/- colposcopy will enable us to identify possible cause.
- Medications: Oestrogen cream, ordinary vegetable oil is the best lubricant (most other lubricants have alcohol/preservatives which may irritate).
- Therapy: De-sensitisation therapy + counselling or sex therapy
- Drugs: Depends on the underlying problem; antibiotics, oral Endep, Amitriptyline 2% cream vaginally or some anti-epileptic drugs may be used.
- LASER: a non invasive treatment for reshaping and revitalising of scar tissue and atrophic mucosa of the vagina
- Emcyte Platelet Rich Plasma ( PRP ): a non invasive treatment for reshaping and revitalising of scar tissue and atrophic mucosa of the vagina.
- Combination of LASER and Emcyte PRP: the ultimate treatment of chronic atrophic vaginitis.
- Reversal of the scar
- Laparoscopy: Excision of endometriosis, removal of ovarian cysts, adhesiolysis, removal of the fibroids, etc
Some tips and home remedies
- Change positions: Being on top of your partner during intercourse may regulate penetration to a depth that feels good for you.
- Communicate: what feels good and what doesn’t? If you need your partner to go slow, say no.
- Don’t rush: Longer foreplay to stimulate your natural lubrication and delaying penetration until your are aroused.
- Use lubricants: Olive and vegetable oil are most effective, cheap and readily available.
Coping and support
- Until vaginal penetration becomes less painful and bothersome, you and your partner might find other options to be more comfortable, more filling and more fun than your regular routine. Sensual massage, kissing and mutual masturbation can all be good alternatives to intercourse.