Painful sexual intercourse in women- Causes and Treatment.

Often not spoken about, sexual pain is a major burden to many women. It is a well-known cause of anxiety and remains the root of many relationship breakups

These may be associated with previous unpleasant sexual experiences. The Anticipation of fear related to sex often makes the symptoms worse, complicating matters.

Genital pain with attempted or complete vaginal entry can deep pain or superficial pain. Let us discuss the possible causes of sex pain and treatment.

Superficial sexual pain

1. Vulvar vestibulitis syndrome (VVS) causes severe superficial pain with attempted vaginal entry of the penis. Gently touching the vestibule ( the area immediately around the vagina opening) with a cotton swab would cause pain in women with this condition.                                     Treatment- Xylocaine gel (5% in neutral base) applied to vestibule about 10 minutes before sexual intercourse could help. EMLA (lidocaine and prilocaine ) could also help. Simple vulva/vagina hygiene is also necessary- no antiseptic soap, perfumes or douches, use of cotton underwear. See your doctor.
2. Skin infection around the vulva/vagina can cause superficial sex pain as well as dryness of the outer part of the vagina.                            Treatment- It could be dermatitis (eczema) or dermatosis (lichen planus/sclerosis) or ulcerative (Herpes, chancroid, Crohn’s, Behcet’s)- you need to see a doctor and get treated.
3. Female circumcision- reduces the elasticity of the outer area of the vagina because of the scar tissue post circumcision.                                 Treatment- the use of dilators may help as well as the use of water-based lubricants like KY jelly. See your doctor.

Let us discuss the possible causes of deep sex pain and treatment.

• Endometriosis: It is common. Patients with endometriosis have described sex as hell. They want nothing around ‘that area’ and the thought of sex itself gives them serious anxiety. To make matters worse a lot of patients with endometriosis have problems with infertility and painful monthly periods too. Endometriosis is the presence of tissue from the uterus implanting in areas outside the uterus. Many suffer in silence.   Treatment: You need to see a doctor. Definitive diagnosis is via a laparoscope. Acute pain can be treated with NSAIDS like Brufen (when needed) with Oral contraceptive pills like Alesse, Yasmin.

• Fibroids: This is the most common tumor of the female genital tract. More than 80% of black women and almost 70% of white women are diagnosed by ultrasound by age 50. Fibroids are known to cause abortions and subfertility too. Most uterine fibroids are without symptoms but it is well known to cause painful sexual intercourse in women.                  Treatment: See your doctor, there are medical and surgical options available.

• History of multiple sexually transmitted infections: chronic cervicitis and chronic pelvic inflammatory disease can cause sexual pain.        Treatment: Avoid multiple sexual partners or men with multiple sexual partners. (If you must have sex with a suspicious partner use a condom). Treat vaginal infections (foul smelling, discolored vaginal secretions) quickly by going to your doctor. DO NOT TREAT YOURSELF.

• Psychosocial problems: this may cause or aggravate sexual pain. Anxiety, depression, history of sexual assault, female circumcision (especially in adult females) are culprits. Sexual pain related to menstrual cycle, season of the year, physical or mental stress fall into this category too. Treatment: Cognitive behavioral therapy, antidepressants, anticonvulsants are some options but you need to see a doctor.

• Peri/Post Menopause: Dry and atrophic vagina because of the drop in estrogen levels can be a source of sexual pain in these women in their late 40s and above, but it could be as early as 38 in a few.                   Treatment: Topical low dose estrogen e.g. Premarin cream applied to the vagina is preferred to the use of systemic estrogen pills. Increase sexual activity, it improves vaginal pliability and elasticity and reduces symptoms. Topical lubricants help as well.