Although it is not always consulted, feeling pain at the time of penetration during sexual intercourse is a very common problem and should never be considered normal. It can affect women of all ages and although it can be caused by various reasons, one of the most common is the involuntary contraction of the pelvic floor muscles. This contraction is commonly called vaginismus, and it causes partial or total closure of the vagina, which, in addition to pain, prevents penetration. In this post, explains how to treat this problem and what other causes can cause pain at the time of penetration.

1. Vaginismus

Vaginismus can make it painful, difficult, or impossible to have sex, perform a gynaecological exam, or insert a tampon. It is a sexual dysfunction and therefore it should be consulted and treated, as it can be an indicative symptom of other gynaecological health problems (endometriosis, pelvic inflammation, fibroids, sexually transmitted infections, vaginal stenosis …). Although it can also be the consequence of negative previous sexual experiences, lack of desire, a repressive education in childhood or adolescence, problems of vaginal dryness – very frequent as the age of menopause approaches – or, simply, the fear of a pregnancy.

Often times, the cause of vaginismus is a bad first experience , out of fear of feeling pain the first time, because the relationship was not entirely desired, or because the necessary time was not spent to achieve arousal and facilitate lubrication. If left untreated, it can end up causing anxiety, insecurity, frustration, and personal and relationship problems, because it affects both sexual satisfaction and psychological well-being.

The first step is always to consult with a gynaecologist who specializes in sexual dysfunction and to be honest. If you have a partner, it is important to talk openly about this problem and not feel guilty. If you have to do therapy or exercises, it is important that you are informed and that you go, if necessary, to the visits so that you know how to act and help. In general, in addition to a first physical examination and reviewing symptoms and a complete medical history, the doctor may order an ultrasound to examine the internal organs (it can be done abdominally) and rule out possible malformations and diseases such as endometriosis or the presence of fibroids or myomas.

It is very likely that your doctor will tell you to go to a pelvic floor physiotherapy specialist to explain where the vaginal muscles are located and to help you become aware of how they contract and relax. Through specific exercises, breathing techniques or the use of vaginal dilators and massages, the muscles in the area can be relaxed. The answer is usually very good.

2. Organic problems

Pain during intercourse can also be caused by vaginal malformations , pelvic diseases , scars from surgical interventions (for example: episiotomy) or vulvodynia , a dysfunction of nervous origin characterized by chronic pain in the vulvar area, tenderness and stinging on contact. Also, an inflammation of the intestine (from ulcerative colitis , Crohn’s disease ), very severe constipation or other intestinal diseases(infections, gas, etc.) can also make penetration painful. Your gynaecologist must be informed and refer you to the specialist that he / she considers most appropriate.

3. Endometriosis

If the pain is felt in a deeper area, it may be a symptom of endometriosis, cysts, or problems with the uterus. Endometriosis occurs when endometrial tissue leaves the uterus and spreads to other gynecological or organic areas. It often causes pain in the pelvic area, the bottom of the vagina, and the rectum . It is important to go to a center that has specialists in this disease, so that they can address it in a comprehensive way, since it can also compromise fertility. Treatment can be pharmacological or surgical, each case and its evolution must be evaluated, since this disease requires follow-up.

4. Vaginal dryness

It is common in menopause and postpartum, and it can also be caused, in some cases, by taking hormonal contraceptives . In general, in the postpartum case, it is essential to respect the time indicated to resume sexual intercourse and avoid penetration at the beginning, especially if there has been an injury – episiotomy – or tear. Over time, the scars heal and the perineum area regains elasticity. Take some time. For menopause, a lubricant can be used and, if necessary, the doctor may indicate the application of a hormonal treatment, orally or locally (cream or ovules). If it is due to other causes, it is important to detect them and never force penetration if there is not a good lubrication and desire. If the hormonal contraceptive reduces desire and lubrication, a better alternative must be sought. In our center we have a Unit specialized in Regenerative and Functional Gynaecology where you can check what treatments exist to solve this problem. 

5. Infections

They can be of bacterial or viral origin: vaginitis, cystitis … Some, like herpes, affect the vulva and cause pain. They can also be accompanied by a discharge of color or smell different from normal. The treatment should be indicated by your gynaecologist, after conducting an examination and the tests that he considers necessary to determine the cause.

6. Psychological origin

If the problem does not have a physical cause, then therapy with a sexuality specialist will need to be done. Although it may seem complex, you can achieve good results relatively quickly and notice positive changes with just a few sessions. It is also important to take time to improve your self-knowledge of your own body and to enjoy sexuality and contact with your partner without focusing on penetration. In our centre we have a specific Unit to deal with these problems.

Bottom line: feeling pain during intercourse IS NOT NORMAL. You should always inform your gynaecologist to make a diagnosis and indicate what steps to follow to treat this problem and solve it as soon as possible, since in addition to affecting your sexual relations and as a couple, it can be a symptom of other health problems.