Dr. M.J. Bazos MD,
Painful Sex for Women
What is dyspareunia?
“dis-par-oon-ya”) is painful sexual intercourse for women. It can
have many causes. Talk to your doctor if you have this problem because there are
effective treatments for many of the causes.
What are some of the causes of
dyspareunia? Any of the genital
parts can cause pain during sex. Some conditions affect the skin around the
vagina. Some women have a viral infection or vaginal yeast infections, but
sometimes the cause is unknown. The pain from these conditions is usually felt
when a tampon or penis is inserted into the vagina. Sometimes, even sitting or
wearing pants can cause discomfort.
“vag-in-is-mus”) is a spasm of the muscles around the vagina. In
some women, the pain of the spasms is so severe that penile penetration is
impossible. Vaginal dryness can also cause painful sex. This dryness may be
caused by menopause and changes in estrogen levels, or from difficulty becoming
aroused. Sometimes the pain occurs when the penis is in the vagina. Women report
the feeling that “something is being bumped into.” The uterus may
hurt if there are fibroid growths, the uterus is tilted or if the uterus
prolapses (falls) into the vagina. Certain conditions or infections of the
ovaries may also cause pain, especially in certain sexual positions. Past
surgeries may leave scar tissue that can cause pain. Because the bladder and
intestines are close to the vagina, they may also cause pain during sex. We know
that the mind and the body work together. This is seen with sexual problems.
Often the problem that first caused the pain may go away, but you may have
learned to expect the pain. This can lead to further problems because you may be
tense or you may be unable to become aroused. The problem can then become a
cycle and you are caught in the middle.
Negative attitudes about sex,
misinformation about sex and misinformation about the functions of the
woman’s body are often associated with some types of pain. Is painful sex
all in your head? No! But it is important to discuss feelings and difficulties
with your partner and your doctor.
How can my doctor tell what is
causing my pain? Your doctor may ask
you to describe your pain, when it began and any associated problems, and may
ask you to describe what you have tried in the past. For example, is it painful
every time you try to have sex? Are there other problems associated with sex?
These are some of the questions that your doctor will need to discuss with you.
Your doctor may want to examine your genital area.
What will the exam be like?
During the exam, your doctor may apply
a cotton-tipped swab to the area to see if the area around the vagina is
painful. A gentle exam of the vagina and cervix is done with a speculum, similar
to the way you get a Pap smear. For some women, this part of the exam may be
painful. Your doctor may use a smaller than usual speculum (child-sized) to
decrease the discomfort. Or, your doctor may delay the exam until the pain is
under better control. It is important to talk to your doctor before the exam so
you know you can stop the exam if it causes too much pain. Discuss this with
your doctor ahead of time. Many women find it useful to hold a mirror during the
exam to see the appearance of their genital structures.
During the final part of the exam,
your doctor will feel your uterus and ovaries with one hand on the abdomen and
one finger in your vagina. This is similar to exams performed during a pelvic
exam. Will I need any tests?
If your symptoms and exam suggest an
infection, you may need to have tests done to look for yeast or bacteria. If
there is no infection, your doctor may do some other tests, such as urine or
Cystitis Association: www.ichelp.comNational
Vulvodynia Association: www.nva.orgThe
Vulvar Pain Foundation: www.vulvarpainfoundation.org