Ask the Doctor: ‘I’ve been experiencing painful intercourse — what can I do to alleviate this or could it indicate something more worrying?’

“I’m in my early-30s and have been experiencing painful intercourse — what can I do to alleviate this, or could it be a sign of something more worrying?”

Answer from Dr Oxana Hughes, Consultant Gynaecologist, Beacon Hospital

Painful intercourse — medically speaking, dyspareunia — can affect both men and women, however it most commonly affects women. Causes can be physical and psychological. Often this condition can lead to distress and relationship problems.

Depending on the location of the pain, dyspareunia can be superficial – entry pain, and deep – the pain is deeper in the pelvis. The location of the pain may help identify a specific cause and treat the pain or discomfort. Entry pain can be due to vulvar inflammatory skin conditions, such as eczema, Lichen sclerosus, or trauma and scarring after childbirth. It can be due to vaginal dryness, and infections including vulvovaginal yeast infections and STIs.

Inadequate lubrication and dryness can be caused by low oestrogen levels in menopause or after childbirth, medications such as antidepressants or contraception, or lack of foreplay. Superficial dyspareunia can also be due to pelvic floor muscle spasm. A condition called Vaginismus is caused by involuntary spasm of the pelvic floor muscles, which is very painful, and in severe cases makes sexual intercourse impossible.

Deep pelvic pain during intercourse can be positional, which means that changing position can help, or can be caused by a medical condition. These include Pelvic Inflammatory disease, endometriosis and fibroids. Other conditions can include Urinary Tract Infections (UTIs), or irritable bowel syndrome (IBS). Often emotional and psychological factors can play a role in painful intercourse. Anxiety, fear, depression and stress can contribute to vaginal dryness, low libido, vaginismus, or trigger tightening of pelvic floor muscles resulting in severe pain. Past history of violence or abuse often lead to sexual dysfunction and dyspareunia.

In cases where the cause is not obvious, you should visit your doctor, who will take a history and perform a pelvic exam in order to assess the pain and to make a diagnosis. You may need to have swabs done to exclude infections. In some cases, pelvic ultrasound or MRI may be indicated to assess for evidence of fibroids or endometriosis. Treatment aims to relieve the underlying cause.

Medication can treat pain caused by infection or a medical condition. This may include antibiotics, probiotics or hormonal treatment. Lubricants and vaginal moisturisers can also be helpful. In some cases, such as fibroids or endometriosis, surgery may be required. In other cases, such as pelvic floor muscle spasms , pelvic floor physiotherapy is the solution. History of sexual abuse, trauma, emotional issues and stress can be the root cause of dyspareunia. In these cases, psycho-sexual counselling is very helpful.

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