Painful sex, why does it happen to me?

Pain during sexual intercourse is a more frequent problem than is usually thought and is not exclusively female but affects women more than men. Why me? It is the question that the affected ones usually ask themselves. Two sexologists explain the possible causes and answer affirmatively to the most relevant question: does it have a solution?

Ana Belén Carmona Rubio, psychologist and sexual and couple therapist points out that it is more appropriate to “talk about painful intercourse (or dyspareunia) than painful sex, since most sexual relationships (kisses, caresses, oral sex , masturbation...) do not produce pain; Only intercourse can cause pain in women in certain circumstances. ”

There is another aspect that should be clarified: the difference between vaginismus and dyspareunia. “Vaginismus is an involuntary contraction of the vagina that makes it impossible to introduce the penis, fingers, tampons or speculums,” explains Carme Sánchez, sexologist and co-director of the Institute of Sexology of Barcelona (InSexBcn) . "It is not a very frequent disorder, but it causes a lot of suffering in the women who suffer it and also in their partners".

Dyspareunia does allow penetration, but with more or less intense pain, and is a much more common problem. " It is the third cause of consultation with specialists in gynecology," says Sanchez.

Causes of pain during intercourse

Among the possible causes of pain in intercourse, Carmona cites "some infections or gynecological or medical issues," although he adds that "it may also be due to penetration relationships when there is little desire or lack of vaginal lubrication."

Given the possibility that the cause is physical, it is advisable to go first to the gynecologist to rule out any vaginal infection, malformations, scars or other diseases in the genital area. We must also consider whether the problem arises "in postpartum or menopause, stages in which hormonal factors can play an important role," says Sánchez.

Dyspareunia occurs in women of different ages: usually, before 30 until more than 50. Carmona describes the typical profile of those who attend a sexology consultation: “They are women who, in general, have a stable partner, who has a time with pain and have previously consulted with their doctor (usually, their gynecologist), who often tells them that he does not find any gynecological explanation for pain ”. In other cases, it is the medical specialists themselves who refer the sexologist to their patients because, although there is a physical cause for painful intercourse, "they consider that sexological work is necessary."

Different treatments depending on the origin of the pain

Sanchez explains that purely psychological causes are more frequent in vaginismus, which may be due, among others, to the fear of pain in early sexual intercourse, the terror of unwanted pregnancy, false beliefs about the body itself, a very education restrictive regarding sexuality or having suffered traumatic experiences such as sexual abuse. The treatment uses "techniques such as systematic desensitization with the help of dilators and sensory enhancement, as well as truthful sexual and anatomical information."

The treatment for dyspareunia is usually "pharmacological, although in some cases it also affects psychosexual aspects, such as disagreements with the couple. Sometimes it is essential to use gels or lubricating creams to minimize discomfort. "

Carmona agrees on the need to individualize the treatment: “Depending on the cause of the pain, the solution can be a sexual or couple therapy, a medical treatment, physiotherapy ... In any case, to know how to solve these problems, first, there is to find out the causes. "

A good relationship is key because, as Carmona points out, "the solution for painful intercourse often happens because of the temporary suspension of intercourse." In this sense, many women "do not finish solving this problem well if their partners do not live well the renunciation of intercourse and are continually pushing them to maintain relationships of penetration as soon as possible". Therefore, including the affected couple in sexual therapy is usually a good idea.

Sex education, the best prevention

Good sex education is the safest way to prevent intercourse related to pain. “Many women suffer from a lack of sexual self-knowledge, ” says Sánchez. "That women learn to know and appreciate their vulvas - and also to enjoy them - is the best resource to avoid pain problems motivated by the absence of lubrication and inappropriate erotic practices," adds Carmona.

This self-knowledge also helps to discover medical problems in time: "Women who look at their vulva can detect certain ailments beforehand". The sexologist concludes with a recommendation: "If it hurts during intercourse, focus on other types of erotic relationships while you find the solution."