Klinik Temasya
Sexual Health

Painful sex 

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Whilst it's not a daily topic of discussion for many, painful sexual intercourse is a serious issue and often physically and pyschologically distressing and can lead to strain in the relationship, loss of intimacy and even depression. 

Many women suffer a degree of discomfort during intercourse from time to time, but when is it the time that we should seek help for our symptoms? If you experiencing persistent pain during sexual encounter, often associated with abnormal vaginal discharge, menstrual issues and its affecting your relationship and sex life then its probably best to talk your doctor as soon as possible. 

When we discussed painful intercourse, I often asked patient where does the pain orginated from? Is it superficial or is it deep pain? For superficial pain during intercourse, the causes are often external. The pain is usually felt at the entrance of the vulva and vagina area and often make penetration difficult. This can be divided into several causes such as vaginismus, vulvodynia, imperforate hymen, genital dermatological diseases and genital skin infections. 

Vaginismus is an involuntary contraction of the pelvic floor muscles around the vagina, resulting in pain and failure to receive ull penetration usually in response to triggers like fear and anxiety. These painful pelvic muscle spasms that occur are unintentional and women may be completely unaware altogether that this is happening. This may affect a women's ability to have a successful penetrative sexual intercourse, painful insertion of tampon and speculum examination at the doctor

Vulvodynia is a chronic localized pain over the vulva region of unidentifiable cause for at least 3 months. It is characterized as a burning, stinging, irritation or sharp pain that occurs in the vulva and entrance to the vagina. However, its a diagnosis of exclusion after other causes such as genital skin diseases and cancer has been excluded

Genital skin diseases such as eczema, psoriasis, lichen sclerosis and xerosis cutis can cause the skin to become dry, cracking with painful fissures. Factors such as hormonal changes from breastfeeding, hormonal contraceptive use and menopause can exacerbate the dryness. Use of harsh soap, hot water and scented feminine products can also worsen the skin conditions. Often vaginal infections with Candida or urinary tract infection can co-exist and further worsen the conditions

Imperforate hymen means lacking the normal vagina opening. A thin membrane called the hymen normally surrounds the opening of the vagina with a small, circular opening in the center. In the case of a completely imperforate hymen, this membrane does not have an opening, so it blocks the vaginal canal and hence making sex painful. A surgery called 'hymenectomy' is performed to remove the hymen and artificially open the vagina. 

Deep pain during sexual encounter are usually felt internally in the cervix and pelvic area. It usually felt during and after the penetration. This can be due to several causes such as endometriosis, pelvic inflammatory diseases, pelvic congestion syndrome and masses within the pelvic organ.

Endometriosis is a disorder in which tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity. The lining of your uterus is called the endometrium. Endometriosis occurred when endometrial tissue grows on your ovaries, bowel, and tissues lining your pelvis. It causes pain over the lower abdomen, infertility and deep pain during intercourse, abnormal menstruation, urination and bowel movement.

Pelvic inflammatory disease or PID is an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes and ovaries. Untreated infection cause scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract, which can cause infertility, ectopic pregnancy and chronic pelvic pain. It also cause abnormal vaginal discharge, fever, pain on intercourse and abnormal period.

Pelvic congestion syndrome is a pelvic pain occur when varicose vein develop around the ovaries, similar to varicose vein that occur in the legs not functioning normally causing blood to back up and veins to become engorged or "congested," which can be very painful. It is very common in women of childbearing age who have had more than one pregnancy. It may start during or after pregnancy and worsened when walking, standing and having sex.

Structural issues like retroverted uterus, uterine fibroids, adenomyosis or any masses occupying the pelvic area such as ovarian cancer can also lead to painful sexual intercourse

Painful sex can also be caused by non-physical causes such as psychological issue such as depression, excessive stress, relatioship issue and other causes of female sexual dysfunction such as low libido, lack or orgasm and hormonal disorders. You do not need to suffer in silence. Visit us for a consultation  with our female doctor today for more information

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