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Dyspareunia: Healing painful sex

Painful intercourse can be devastating for women and their relationship(s). It runs counter to our expectation of sex being pleasurable; aside from consensual BDSM sex, sex should not hurt. Physicians have only recently begun to take women’s pain during sex seriously. It had long been dismissed and framed as a sign of neurosis. Imagine being both in pain and belittled. Thankfully more and more medical professionals are recognizing the signs and symptoms of painful intercourse and are helping women to get proper treatment.

What exactly is pain during intercourse? There are several conditions under this umbrella (see our blog on Vaginismus for an overview of that condition). This blog focuses on Dyspareunia: persistent or recurrent genital pain that occurs just before, during or after intercourse. This pain can be triggered by the insertion of a tampon, finger, or penis, and intensify during thrusting. Burning, aching, or throbbing can also occur briefly or for several hours after insertion.

Dyspereunia can lead a woman to feel isolated, as oftentimes the condition is kept secret. The universal assumption is that sexual intercourse is supposed to be pleasurable, so sufferers tend to quickly question what is wrong with them. Is it in their head? In their vagina? Is it both? When something we expect to be normal and pleasurable is not, it is confusing. Dyspereunia almost always has a deteriorating effect on romantic/sexual relationships. Sadly, some men do not believe when a woman tells them that they are in pain. They think it is in their head, it will pass, or dismiss the idea altogether without any discussion or attempt at easing the pain.

It is true that sex can be painful, but it is also true that treatments exist that can reduce or eliminate it. Both physical and emotional components to dyspareunia need to be considered since pain involves both the body and the mind. Also, if one route of treatment does not bring much change in the pain, the other route is worth exploring. Oftentimes a combination of physical and emotional factors are associated with dyspareunia. This is because initial pain can lead to a cycle of fearing future pain, which makes it difficult to relax and can loop back to more pain. Starting out by consulting with your physician is a great way to identify the cause(s) of painful sex in order to set you on a tailored treatment plan. Causes can include:

– Not enough lubrication
– Injury trauma, or irritation to any part of the vagina
– Inflammation, infection, or skin condition
– Allergic reactions (e.g., to latex condoms)
– Medical conditions (e.g., endometriosis, irritable bowel syndrome, ovarian cysts)
– Prior surgeries in the genital area
– Psychological contributors (e.g., sexual trauma, stress, anxiety, depression, poor body image, fear of intimacy)
– Relationship problems

Once you have a better sense of the cause(s) of painful intercourse, treatment can include one or more of the following:

– Experimenting with sexual positions (e.g., to control the depth of thrusting, which can be painful)
– Improving communication with your romantic/sexual partner (what causes pleasure and what causes pain)
– Extending foreplay (30 to 45 minutes to avoid penetration before the woman is receptive, which causes pain; kissing, cuddling, whole-body massage, and oral sex before attempting penetration)
– Using artificial lubricant and avoiding medications that diminish lubrication
– Experimenting with sex toys, especially external ones (remaining sexual even without penetration, and regaining orgasm)
– Estrogen therapy (insufficient estrogen can cause lack of natural lubrication)
– Desensitization (gradually decreasing the fear of intercourse and relaxation exercises to relax the mind, body, and vagina)
– Counselling or sex therapy (changing the negative emotional response to sex that has built up; working on relationship issues that contribute to emotional pain, triggering physical/sexual pain; talking about what is happening and about your feelings; getting a better sense of what brings you each physical and sexual pleasure; broadening your concept of sex to include activities other than penetration; sensate-focus)

Having a solid grasp of causes and treatment options will help you and your partner to form a plan for how to deal with dyspareunia. Avoidance is not an option. Even when you experience painful intercourse, you do not want to give up on sex altogether. Remember that intercourse is no necessary for great sex. You can experience sexual pleasure from the hands, the tongue, toys, even feet. Keep communication open, set up optimal conditions, and and keep trying.

If you need support in taking charge of sexual pain, we can help you to better understand and deal with the problem as well as to decrease relationship distress. Reach out to us at 514-223-5327 and begin counselling with one of our experienced therapists.

Written by: Andrea Guschlbauer, Ph.D., OPQ., Psychologist


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