How to Prevent Painful Sexual Intercourse

Diagnosis

A medical evaluation for dyspareunia usually consists of:

• A thorough medical history. Your health care provider might ask when your pain began, where it hurts, how it feels and if it happens with every sexual partner and every sexual position. Your provider might also inquire about your sexual history, surgical history and childbirth.

  Don’t let embarrassment stop you from answering truthfully. These questions provide clues to the cause of your pain.

• A pelvic exam. During a pelvic exam, your provider can check for signs of skin irritation, infection or anatomical problems. He or she might also try to locate your pain by applying gentle pressure to your genitals and pelvic muscles.A visual exam of your vagina, using an instrument called a speculum to separate the vaginal walls, might be performed as well. Some women who have painful intercourse also have discomfort during a pelvic exam. You can ask to stop the exam if it’s too painful.
• Other tests. If your provider suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.

Treatment

Treatment options vary depending on the cause of the pain.

Medications

If an infection or medical condition contributes to your pain, treating the cause might resolve your problem. Changing medications known to cause lubrication problems also might eliminate your symptoms.

For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina.

The Food and Drug Administration approved the drug ospemifene (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining.

Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium).

Another drug to relieve painful intercourse is prasterone (Intrarosa). It’s a capsule you place inside the vagina daily.

Other treatments

Certain nonmedication therapies also might help with dyspareunia:

• Desensitization therapy. You learn vaginal relaxation exercises that can decrease pain.
• Counseling or sex therapy. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you might also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.

Lifestyle and home remedies

To help with pain during sex, you and your partner could try to:

• Change positions. If you have sharp pain during thrusting, try different positions, such as being on top. In this position, you might be able to regulate penetration to a depth that feels good to you.
• Communicate. Talk about what feels good and what doesn’t. If you need your partner to go slow, say so.
• Don’t rush. Longer foreplay can help stimulate your natural lubrication. You might reduce pain by delaying penetration until you feel fully aroused.
• Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like.

Coping and support

Until vaginal penetration becomes less painful, you and your partner might find other ways to be intimate. Sensual massage, kissing and mutual masturbation offer alternatives to intercourse that might be more comfortable, more fulfilling and more fun than your regular routine.

Preparing for your appointment

Talking to your health care provider is the first step in resolving painful intercourse. Your provider might diagnose and treat the problem or refer you to a specialist.

What you can do

To prepare for this discussion with your provider, make a list of:

• Your sexual problems, including when they began and how often and under what conditions they occur
• Your key medical information, including conditions for which you’re being treated
• All medications, vitamins or other supplements you take, including doses
• Questions to ask your provider

Some questions to ask your provider include:

• What could be causing my problem?
• What lifestyle changes can I make to improve my situation?
• What treatments are available?
• What books or other reading materials can you recommend? What websites do you recommend?

What to expect from your doctor

Your health care provider might ask you questions, including:

• How long have you had painful intercourse?
• Where do you feel the pain?
• Does the pain occur every time you have sex or only in certain situations?
• How is your relationship with your partner?
• Are you able to discuss your sexual concerns with your partner?
• Do any nonsexual activities cause you pain?
• How much distress do you feel about your sexual concerns?
• Do you have vaginal irritation, itching or burning?
• Have you ever been diagnosed with a gynecological condition or had gynecological surgery?

Reasons for painful sex

A cure for painful sex isn’t a one-size-fits-all treatment. There are many reasons sex might be painful. Here are a few.

Vaginismus

Vaginismus is a painful condition in which the muscles involuntarily contract or spasm when something enters the vagina. This can make sex difficult and even painful. If the pain subsides after the penis (or even a tampon) is withdrawn, that could be a sign of this condition. It’s been described by women as feeling like tearing, or sometimes like hitting a wall.

Menopause

As women age, they lose a lot of natural lubrication due to hormonal fluctuations. This can make the vagina dry and thin and penetration painful.

Vulvodynia

Vulvodynia is a chronic, painful disorder in which the vulva experiences a burning sensation, itching, rawness, or a general feeling of soreness.

Infections

Vaginal infections (Vaginitis) can cause painful sex. You might notice an odd smell, or a burning and itching sensation. An infection can be many things such as:

• Chlamydia
• Bacterial vaginosis
• Gonorrhea
• Yeast infections
• Allergic reactions
• Trichomoniasis
• Viral vaginitis

These are only a few reasons you may be experiencing painful sex. Luckily, there are things you can do at home to relieve some of the pain.

What you can do at home

While you should have regular OB/GYN Wellness checkups, It’s not necessary to see a doctor for some of these problems. Here are some things you can try at home.