Although it is not always consulted, feeling pain at the time of penetration during sexual intercourse is a very common problem and should never be considered normal. It can affect women of all ages and although it can be caused by various reasons, one of the most common is the involuntary contraction of the pelvic floor muscles. This contraction is commonly called vaginismus, and causes partial or total closure of the vagina, which, in addition to pain, prevents penetration. In this post we explain how to treat this problem and what other causes can cause pain at the time of penetration.
1. Vaginismus
Vaginismus can make it painful, difficult, or impossible to have intercourse, have a gynaecological exam, or insert a tampon. It is a sexual dysfunction and therefore, it should be consulted and treated, since it can be a symptom indicative of other gynaecological health problems (endometriosis, pelvic inflammation, fibroids, sexually transmitted infections, vaginal stenosis…). Although it can also be a consequence of previous negative sexual experiences, lack of desire, a repressive upbringing in childhood or adolescence, vaginal dryness problems – very common as menopause approaches – or simply the fear of a pregnancy.
Often, the cause of vaginismus is a bad first experience , for fear of feeling pain the first time, because the intercourse was not entirely desired or because the necessary time was not dedicated to achieving arousal and facilitating lubrication. If left untreated, it can end up causing anxiety, insecurity, frustration, and personal and relationship problems, because it affects both sexual satisfaction and psychological well-being.
The first step is always to consult with a gynaecologist specialized in sexual dysfunctions and to be honest. If you have a partner, it is important to talk openly about this problem and not feel guilty. If you have to do therapy or exercises, it is important that she is informed and that she attends visits, if necessary, so that she knows how to act and help. In general, in addition to a first physical examination and review of symptoms and a complete medical history, the doctor may request an ultrasound to examine the internal organs (it can be via the abdomen) and rule out possible malformations and diseases such as endometriosis or the presence of fibroids or fibroids.
Your doctor will most likely direct you to see a pelvic floor physiotherapist who can explain where your vaginal muscles are located and help you become aware of how they contract and relax. Through specific exercises, breathing techniques or the use of vaginal dilators and massages, the muscles in the area can be relaxed. The answer is usually very good.
2. Organic problems
Pain during intercourse can also be caused by vaginal malformations , pelvic diseases , surgical scars (for example: episiotomy) or vulvodynia , a dysfunction of nervous origin that is characterized by chronic pain in the vulvar area, hypersensitivity and stinging on contact. Also, an inflammation of the intestine (due to ulcerative colitis , Crohn’s disease ), very intense constipation or other intestinal diseases(infections, gases, etc.) can also make penetration painful. Your gynecologist should be informed and refer you to the specialist they consider most appropriate.
3. Endometriosis
If the pain is felt in a deeper area, it may be a symptom of endometriosis, cysts or problems in the uterus. Endometriosis occurs when the endometrial tissue outside the uterus and spreads to other gynecological or organic areas. It often causes pain in the pelvic area, the bottom of the vagina, and the rectum . It is important to go to a center that has specialists in this disease, so that they can address it in a comprehensive way, since it can also compromise fertility. The treatment can be pharmacological or surgical, each case and its evolution must be assessed, since this disease requires follow-up.
4. Vaginal dryness
It is common in menopause and postpartum, and can also be caused, in some cases, by taking hormonal contraceptives . In general, in the case of postpartum it is essential to respect the indicated time to resume sexual intercourse and avoid penetration at first, especially if there has been an injury – episiotomy – or tear. Over time, the scars close and the perineal area regains its elasticity. Take some time. for menopause, a lubricant can be used and, if necessary, the doctor can indicate the application of a hormonal treatment, orally or locally (cream or suppositories). If it is due to other causes, it is important to detect them and never force penetration if there is not good lubrication and desire. If the hormonal contraceptive reduces desire and lubrication, a better alternative must be sought. In our center we have a Unit specialized in regenerative and functional Gynecology where you can consult what treatments exist to solve this problem.
5. Infections
They can be of bacterial or viral origin: vaginitis, cystitis … Some, like herpes, affect the vulva and cause pain. They may also be accompanied by a discharge that is different in color or smell than normal. The treatment must be indicated by your gynecologist, after carrying out an examination and the tests that you consider necessary to determine the cause.
6. Psychological origin
If the problem does not have a physical cause, then therapy with a sexuality specialist will be necessary. Although it may seem complex, you can achieve good results relatively quickly and notice positive changes with just a few sessions. It is also important to spend time improving self-awareness of one’s own body and enjoying sexuality and contact with a partner without focusing on penetration. In our center we have a specific unit to deal with these problems.
In short: feeling pain during intercourse is NOT NORMAL. You should always inform your gynecologist so that they can make a diagnosis and tell you what steps to take to treat this problem and solve it as soon as possible, since in addition to affecting your sexual and partner relationships, it can be a symptom of other health problems.
