Painful sex

Why do we need to talk about painful sex?

• Sometimes sexual penetration, or intercourse, can cause pain and discomfort.
• This is NOT normal.
• Most women with a vulval problem experience some kind of discomfort with sexual intercourse.
• The vulva and vagina are sexual organs and as such are very sensitive. There are many nerve endings in the skin which, while able to give sexual sensations, can also produce pain.

What happens normally during sexual arousal?

There are a number of important physical changes that happen during sexual excitement. These changes are necessary to prepare the vulva and vagina for penetration in such a way that sex does not normally hurt:

• When a woman becomes sexually ‘turned on’ the vagina secretes a fluid. This fluid acts like lubrication so that the penis will not produce friction against vaginal skin.
• The outer and inner lips (labia) become filled with fluid and so stand erect, opening up the entrance to the vagina. This makes it easier for the penis to enter the vagina.
• The clitoris becomes bigger and more easily stimulated. This gives the woman more sexual pleasure.
• The pelvic muscles around the vagina become relaxed. This prevents any uncomfortable resistance to the moving penis.
• The upper part of the vagina itself enlarges to provide more space for the erect penis. This may also help prevent bladder bruising such as in ‘honeymooner's cystitis’.
• The cervix lifts up, out of the way of the penis. This prevents any pain caused by the penis knocking against the cervix (deep pelvic pain).

Therefore, it is important that you make sure you are sufficiently excited before penetration begins. To do this you will need foreplay or ‘sex play’ that suits you. It will help if you can tell your partner how to help you feel aroused as most people need this guidance.

What might happen if I have vaginal penetration (intercourse) when I am not excited enough? What might happen if I have vaginal penetration when I have a vulval problem?

• If a woman has sexual intercourse when she is not ‘turned on’ and therefore unprepared, she is more likely to feel some kind of pain or discomfort in the vagina or vulva, even if she does not have a medical problem in the vulva. This discomfort may be due to rubbing or tearing of the skin.
• If a woman is not turned on during sexual intercourse she may feel that sexual relations are not satisfying for her.
• Pelvic pain with intercourse can also occur in the general pelvic area. This pain may be due to the penis hitting against internal organs.
• You may find that having penetration is not possible because the opening to the vagina is ‘closed’ or tight.
• You may feel dry during intercourse. This dryness can produce a burning sensation with the friction. Other sensations may include stinging, throbbing or a tearing sensation.
• If you have a medical problem or tearing or damage to the skin, you may see some bleeding. Sexual activity may worsen the vulval symptoms and complicate recovery.
• If your medical condition is already painful you may expect pain with intercourse and tense up your muscles. This will make the sexual pain worse.

What can I do about painful sex or other sexual problems?

• If you feel pain or discomfort or begin bleeding with penetration, you should stop penetration. ‘There is no gain with pain’.
• Don’t do anything sexual that hurts.
• It is important to see a doctor or health carer whom you believe is comfortable talking about sex with you. When you find a doctor/health carer who is able to investigate the sexual problems it is better to stay with the one carer rather than have a number of carers for the same problem.
• You may need to have swabs or other tests to make sure you don’t have a medical problem in the vulva. Some difficulties with sex are caused by medical problems such as contact dermatitis or infections or lichen sclerosus. Some sexual discomfort is caused by over treatment with creams, for example the creams used to treat yeast infections which can be toxic to some women. Some sexual discomfort may be caused by (or made worse by) harsh hygiene methods.
• It may be necessary for you to see a physiotherapist (physical therapist) as some pain with sex, or difficulties with the penis entering the vagina, are due to chronic muscle tension. This condition is known as vaginismus. It may arise out of anxiety.
• You may need to see a sexual therapist or a psychologist as some sexual problems can be due to anxiety, depression or life stresses and not being ‘turned on’. Some sexual discomfort may also be connected to relationship problems and/or past experiences.

Can I use products such as lubricants to help with painful sex?

• The use of products such as artificial lubricants is not recommended. Most products used for sex contain chemicals that can irritate vulval skin, especially if there is a medical problem already present. If you are not naturally lubricated sexual penetration should not take place until you are sufficiently aroused.
• If dryness (for instance after menopause or during lactation) is the only reason for pain with sex then a simple lubricant such as vegetable oil may help and will not irritate your skin. A locally applied oestrogen cream or pessary may also help. You should see your doctor about this.
• Some health carers suggest using a local anaesthetic cream during sex to dull symptoms. For the genitals to respond to gentle sexual stimulation the nerve endings need to be functional. If you use an anaesthetic cream so you can have sex you may lose the chance to feel sexual pleasure. Do not have penetration if it hurts you.
• Using such products to help you have sex is not a good idea as they may only mask or cover up the real problem. The real problem may be that you are not sexually aroused or you have a medical problem that you have not yet recovered from.

How will I know if the sexual discomfort has gone and I can have sexual penetration again?

• Never have painful sex.
• Many cases of sexual discomfort may take some time to recover from. There is no ‘quick fix’, especially if the nerves have been irritated. This may be the case even if the skin is better.
• Try to touch your vulva and vagina using your own fingers, perhaps under the shower. If you feel that there is still some discomfort then you know that you can have any kind of sexual activity you like, but not penetration.
• If you discover that inserting your own fingers into your vagina is not uncomfortable anymore then experiment gently with your partner. However, before penetration occurs it is important to be very sexually excited. To achieve this, talking openly with your partner will help you get the kind of stimulation you prefer. Other people cannot know what you find exciting. Often beginning with oral sex on the woman can help if the woman feels dry. Saliva is a natural lubricant.
• When you want to try sexual penetration try a position where you are on top of your partner. In this position you can control penetration and can stop it if you are not ready yet.