Pain starting immediately after initiating intercourse must be evaluated further. Usually there no pain if the partner is stimulated well before starting intercourse. But, in some women even after proper stimulation there will be sharp pain immediately after starting intercourse which makes the couple feel depressed.

 Most common causes which can lead to painful intercourse or penetration are as follows:

  1. Intercourse for the first time or first few times of intercourse can lead to pain during penetration which can be due to unstretched hymen.
  2. Lack of sufficient lubrication can also lead to pain.  This can be due to improper stimulation before starting intercourse.
  3. Vaginal infections like candidiasis and trichomoniasis or any other sexually transmitted diseases can be the cause of painful penetration.
  4. Vaginismus is a condition in which there are spasms of the vaginal wall muscles which lead to immediate tightening when there is penetration, which leads to intense pain.
  5. Any injury to the external structures can lead to pain. But it is a temporary condition which resolves after cure from that injury.
  6. Psychological issues like anxiety, depression, concerns about her physical appearance, fear of intercourse or relationship problems can lead to a low level of arousal resulting in discomfort or pain in a woman.
  7. Any conditions related to Bladder, cervix or uterus like urinary tract infections, cervicitis, endometriosis, fibroids etc. can lead to deep pain during intercourse.
  8. Stress in life, inabilityb to relax can lead to tightening of pelvic floor muscles during intercourse which can lead to pain.
  9. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. One might start avoiding sexual intercourse if it is associated with pain.
  10. Menopause is one condition where due to hormonal changes there will be dryness in the vagina which can lead to pain during intercourse.

What can be done to ease things?

  1. Consulting a gynecologist for a physical examination is the first thing which you need to do.  This will help you to figure out the exact reason behind this pain.
  2. If the cause is a medical condition, treatment for that particular condition. Example: if infection is the cause, taking treatment with antibiotics or antifungal medication can be the solution.
  3. Most common reason for painful penetration is inadequate lubrication. So, using water based lubricants are advised. Foreplay plays an important role for natural lubrication. You might reduce pain by delaying penetration until you feel fully aroused.
  4. Painful intercourse can lead to emotional disturbance  even after treatment. If you and your partner have avoided intimacy because of painful intercourse, communication with your partner in restoring sexual intimacy will help. Talking to a counselor or sex therapist can help resolve these issues.
  5. Trying different positions to avoid sharp pain, such as being on top is advisable. In this position, you may feel less pain.
  6. Pelvic floor exercises like Kegel’s exercise can help you to loosen your muscles which are leading to tightness during penetration especially in the case of vaginismus.
  7. Stress relieving techniques can also be helpful, if stress is the cause.
  8. If depression is the cause then consulting a psychiatrist is very important. Treatment for depression and psychological counselling can ease things for you.
  9. Emotional support is very important by your partner during this period. Until vaginal penetration becomes less painful, you and your partner might find other ways to be close and have intimacy.

Kegel’s exercise: Muscles used to stop the flow of urination are used to do kegel’s exercise.To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you’ve got the right muscles. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Keep working on them and you must attain at least holding them for 10 secs at a time and relaxing for 10 seconds between contractions. You can do 4 in  row for better results.

If you have any confusion about performing Kegel’s exercises, ask your gynecologist for guidence.

References:

https://www.webmd.com/sexual-conditions/guide/female-pain-during-sex#1

https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973

 

-Dr.Y. Alekhya

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