Sex - Painful

"I hate having sex these days - it's too painful"

There are lots of reasons why sex may become painful - even when the problem has been sorted out it can take a long time before sex becomes enjoyable again. You definitely need help from your doctor for this symptom - it's not something you can sort out on your own.

Before you see your doctor, try to be clear in your mind whether the pain occurs:

• when your partner attempts to put his penis into your vagina (superficial pain)
• when the erect penis is fully inserted and during thrusting (deep pain)
• in the hours after sex.

Causes of pain at the entrance of the vagina during sex

After childbirth, some women experience pain when they start having sex again. It is more likely after the first baby. Sometimes it is due to an episiotomy that hasn't healed properly. The pain almost always goes away after about 3 months.

A dry vagina is one of the most common reasons (see Dry vagina).

Infections, such as thrush or herpes, make the vulva (lips round the opening of the vagina) sore. Vaginal discharge causes chaffing of the skin, which makes the problem worse.

Blocked Bartholin's glands. Bartholin's glands are just inside the opening of the vagina, one on each side. They help produce lubrication for sex. If the opening of a Bartholin's gland becomes blocked, it swells up into a cyst. Bacteria may enter the cyst, turning it into a painful abscess.

Skin irritants such as perfumed soaps, bubble baths, biological (which means that they contain enzymes) washing powders, 'intimate' deodorants and spermicides can all make the vulva sore.

When sex causes pain deep inside

Pelvic inflammatory disease is an infection of the Fallopian tubes (the tubes, one each side, that carry the egg from the ovaries to the uterus). These tubes lie close to the top of the vagina, so sex causes a deep pain.

Endometriosis is a peculiar condition, in which some of the tissue that normally lines the uterus (sometimes called the womb) lies outside the uterus, in the pelvic cavity. No one knows why it occurs, though it seems to be quite common. Many women have no symptoms from it, but if the tissue is lying behind the uterus it can cause painful sex, especially on deep thrusting. A sign of endometriosis is bad period pains - especially if they last throughout the period.

Pelvic pain syndrome. For two out of every three women with deep pain during sex, no cause can be found; you may have to accept that you have pelvic pain syndrome. This syndrome is not fully understood, but it is related to stress. One possible, but not proven, explanation is that, in some women, chronic stress alters the flow of blood in the veins of the pelvis, so that the pelvis becomes congested. If you are easily aroused during sex, but have difficulty reaching orgasm, the problem becomes worse because the pelvic congestion is not relieved. You may then experience a pain that persists after sex for some hours.

Lack of arousal. Intercourse will be uncomfortable if penetration occurs before you are aroused. This is partly because of lack of lubrication, but also because with sexual arousal the upper part of the vagina balloons open. This helps to lift the womb up and away from the thrusts of the penis. If penetration occurs too early, there may be a pain or discomfort felt deep in the middle of the pelvis with each thrust.

Other causes include irritable bowel syndrome (IBS) and cystitis - the bladder and bowel both lie close to the vagina.

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