Possible causes of pain during sexual intercourse in women. Pain during sex: causes and treatment Sharp pain in the lower abdomen during intercourse

Painful sensations during sexual intercourse is a fairly common problem that worries the female half in most cases, affecting any age range of the life cycle. Many people do not pay due attention to warning signs, determining their insignificance and hoping for a quick and favorable outcome of the anxiety that has arisen.

The mechanism for the formation of pain during sexual intercourse is the development of a characteristic symptom when the penis is inserted into the lumen of the vagina at the initial stages or with deeper penetration and subsequent jerking movements. Various factors can contribute to the occurrence of pain, which include not only organic manifestations in changes in the physiological parameters of the female body, but also psychological disorders.

Pain during sexual intercourse: causes

Photo: Pain during sexual intercourse

Identifying the true cause of the development of a pain symptom requires a more in-depth study of the problem and establishing the degree of arousal of the female body before sexual intercourse. Insufficient preparation for the rapprochement process can occur in the following situations:

• instability of relationships with one partner;
• existing conflict of reciprocity;
• not using pre-stimulation techniques and techniques.

In such a situation, the psychological factors of pain formation are very quickly triggered in the absence of sufficient hydration of the vaginal mucosa, and with the constant repetition of the use of inadequate techniques of mutual caress and play, this is an expected factor in sexual intimacy.

Characteristics of pathological changes

During sexual intercourse, it can be a sign of various forms of pathological disorders affecting any anatomical area of ​​the female genital area, and having various causes underlying the disease. The main group of infectious pathological conditions that cause the development of pain symptoms include:

• Endometriosis. It represents a pathological proliferation of the mucous tissue of the uterus with their possible appearance in its internal tissues, affecting the muscular or serous layer, as well as nearby organs, namely in the ovaries, abdominal surface, walls of internal structures.
• An adhesive process that affects organs located in the retroperitoneal space. Pathology is formed after suffering a form of acute inflammatory process, manifested by the occurrence of pain in women during sexual intercourse.
• Vaginitis. Refers to the inflammatory process that develops when a pathogenic pathogen is introduced into the body, which includes the entire group of infections transmitted through sexual intercourse. In addition, the disease can develop due to hormonal instability of the female body.
• Cystitis, . The pathological process of inflammation affects the urinary organ and the channel for removing fluid from the body.
• Chronic form of salpingitis, cervicitis, endometritis. Characterizes a sluggish process of inflammation with the periodic manifestation of stages of its exacerbation, which are determined by the typical symptoms of the disease.

Organ disorders

The following conditions that provoke the development of pain during sexual intercourse in women are classified as non-infectious characteristics of the disorder:

It should be pointed out that there is a common assumption of size incompatibility between partners, which can cause pain during intercourse. This is a very rare condition, since the walls of the vagina are extremely elastic and, with a sufficient phase of female arousal, can accommodate the existing size of the partner. The only exception to this rule can be the manifestation of clinical signs of gigantism in a man.

Pain symptom manifestation parameters

The formation of a disturbing symptom during sexual intimacy can manifest itself in the following cases:

• directly when the penis is immersed in the vaginal space;
• at the first sexual intercourse;
• during physical activity;
• after the process is completed.

Why is there pain after intercourse? The sensations that arise are perceived differently by each woman, taking into account the intensity of their expression. Signs may have the following types of manifestation, characterizing the presence of pain symptoms:

• tingling;
• discomfort;
• acute attack of pain or nagging sensation.

The presence of constant pain of low intensity is typical for non-infectious disorders. Development severe pain after intercourse indicates a pathology of the structures of the genital area of ​​an acute inflammatory form, requiring a comprehensive diagnostic examination. If the cause of the development of pain discomfort is psychological factors, then the symptom may have a different distribution and disappears spontaneously when the partner or environment changes.

The structure of localization of sensations

Most often, the manifestation of pain at the beginning of sexual intercourse is associated with the development of complications of various pathological disorders, such as infection of the vestibule and lips, drying of the mucous membrane, vaginismus, etc. During the diagnostic process, a specialist visually determines the presence of deformation lesions of the tissues of the genital area. Palpation of the urinary organ and the presence of pain during urination after sexual intercourse indicates the development of urethritis, to establish the specifics of the course of which additional laboratory examination is carried out.

Internal pain in the lower abdomen during sexual intercourse is a consequence of current pathological disorders, namely:

• adhesions, endometriosis, congestion;
• less often inflammatory process and weak muscle tone;
• pathologies of the urinary system, when, against the background of frequent emptying of the urinary organ, burning and pain in the urethra, pain symptoms are observed during sex;
• diseases of the intestinal tract, identifying a localized inflammatory process, which may be accompanied by abdominal pain during sexual intercourse.

Psychological aspects of pain

The occurrence of painful discomfort during sexual intercourse can also develop on a subconscious level, affecting the psychological sphere of perception of the female body. Depending on the level of intensity of their manifestation, a woman may intuitively refuse sexual contact. These parameters include the following characteristics:

• Feeling of fear before sexual intimacy. It occurs at the beginning of sexual life, creating a sensation of pain during the first sexual intercourse, which is provoked by a rupture of the virgin septum of the vagina.

The reasons for the development of fear may be the partner’s incompetence in the technique of sexual intercourse, fear of unplanned conception, lack of mutual love and other factors that do not allow a woman to mentally relax and receive the required level of pleasure. It is necessary to overcome the threshold of fear on your own; if there is no effect and signs of pain recur, it is recommended to seek advice from a specialized specialist.

Photo: Pain during intercourse

• A sharp, spontaneous spastic contraction of the muscular layer of the vagina, which is called vaginismus, is based on existing fears of past sexual experience. The development of the condition causes pain and does not allow the process to be fully completed.
• Uncertainty and failure, when a woman, concentrating on her own shortcomings, spontaneously develops a fear of sexual intimacy. This condition does not allow one to achieve the required level of arousal and contributes to a more intense perception of pain.

Methods for identifying the causes of pathology and the principle of treatment

Consultation with specialized specialists such as a gynecologist, urologist, psychotherapist, and sexologist will help identify the basis for the development of pain in the lower abdomen after sexual intercourse. As an additional examination to confirm the established diagnosis, the following methods are used:

• laboratory diagnostics;
• ultrasound and tomography examination of the genital organs;
• identification of infectious carriers with identification of the nature of the existing pathogen or confirmation of the level of microflora purity.
• The natural remedy Urethramol, based on natural ingredients, juniper and oak bark, copes well with all male problems, we recommend it for use.

Treatment of abdominal pain that occurs after sexual intercourse or during its process depends on the established causes that contribute to its occurrence. In the current process of acute or chronic inflammation, a spectrum of medicinal effects is prescribed, which completely eliminates the source of the pathological disorder. In some cases, such as endometriosis, fibroids or cystic tissue growth, surgery is also used.

Interesting video about the psychological factors of pain during sexual intercourse

Psychological adjustment of the patient’s condition is carried out independently or during consultation with a psychotherapist. In any case, pain that occurs after sexual intercourse should not be left to chance. Only a competent examination with the establishment of the true causes of its development will help to quickly and effectively eliminate disturbing manifestations, which will naturally restore the fullness and comfort of sexual intercourse.

Considering the multiplicity and multidirectionality of the causes of pain discomfort, it is necessary to remember and value your own health, without expecting the process to resolve itself successfully. The earlier the cause of the development of pain is identified, the faster it will be eliminated along with the provoking factor that caused the development of the pathological disorder.

Pain during sexual intercourse is not a disease, but a rather specific symptom that can occur in females. This condition is medically called dyspareunia.

There is a wide range of predisposing factors that cause pain in women during sex. Not in all cases this is associated with the course of any gynecological disease. It is for this reason that all sources of pain are divided into several large groups.

Since such a symptom can be provoked by pathology, additional clinical manifestations will be the most characteristic symptoms of a particular disease. Often they are itching and burning of the genitals, redness and swelling.

Establishing the correct diagnosis requires an integrated approach and is based on laboratory and instrumental diagnostic techniques. Treatment tactics will directly depend on the etiological factor, but in most cases clinicians are limited to conservative treatment.

Pain during intimate contact is caused by many predisposing factors, which is why they are usually divided into two large groups:

• pathological - this category consists of diseases of the genitourinary system, which can be infectious or non-infectious in nature;
• psychological – associated with the fear of pain during sex.

Thus, diseases that cause such a symptom are presented:

1. – in this case, chronic or acute inflammation develops in the vagina. This disease is often caused by pathological microorganisms and hormonal disorders.
2. - this is the growth of the endometrium of the uterus, particles of which appear in atypical places, for example, the ovaries or peritoneum.
3. is an inflammation of the urethra.
4. – the disease implies the appearance of inflammatory changes in the bladder.
5. sluggish course of endometritis, or.
6. formation
7. injuries, postpartum tears or stitches from gynecological operations.
8. vaginal atrophy - this disorder is better known as, which develops with.
9. insufficient amount of estrogen.
10. impaired functioning of the ovaries or the presence of formations on them.
11. cystic neoplasms and are tumors of a benign or malignant nature that are localized in the organs of the reproductive system located in the pelvic area.
12. bends of the uterus - while it is anatomically incorrectly located in relation to other internal organs of the small pelvis.
13. vulvodynia.
14. venous stagnation in the pelvis.
15. formation of genital warts.
16. varicose veins of the small pelvis.
17. somatic pathologies, which women rarely associate with sexual activity. This should include diabetes mellitus, gastrointestinal diseases, in particular, pathologies of the anus, such as or. Quite rarely, the sources are skin diseases, for example, scleroderma.
18. inflammation of the labia majora.
19. syndrome.
20. hormonal imbalances.
21. congenital anomalies or malformations of the female reproductive system.

Psychological reasons for abdominal pain during sexual intercourse:

• lack of psychological readiness for sex - in the vast majority of cases, this occurs in young girls who are not yet ready to give up their virginity;
• a previously suffered traumatic situation, for example, rape by both strangers and male acquaintances, sexual harassment from close relatives. The trauma that resulted in an unwanted pregnancy is considered especially severe;
• subconscious fears associated with possible infection with an STD or panic fear of having a child;
• different temperaments of sexual partners - if a woman is naturally gentle and calm, and her man is rude in bed, then in such cases pain is a protective reaction of the body;
• loss of a close relative or friend;
• depression;
• period of bearing a child - during pregnancy, some women refuse sexual intercourse;
• psychological trauma that reduces the self-esteem of female representatives. This may be due to infertility, early onset of menopause, previous operations to remove the uterus or breast;
• insufficient arousal of a woman;
• lack of trust between partners.

Separately, it is worth highlighting such a factor in the appearance of cutting pain during sexual intercourse as labor activity. The process of bringing a child into the world can be complicated by numerous tears that undergo stitching. This is what leads not only to pain, but also to a complete lack of pleasure from sexual contact. However, this reason is temporary and goes away approximately six months after the birth of the baby.

It is worth noting that in some cases it is not possible to find out the reasons for such a symptom.

Classification

There are two main forms into which pain during intimacy in women is divided:

1. primary – is when a female representative has no experience of receiving pleasure or positive emotions from sex.
2. secondary - appears in women who previously enjoyed sexual intercourse. Such dyspareunia is formed against the background of the influence of one or more of the above predisposing factors.

In addition, there are several types of this disorder, which differ in the location of pain. Thus there is:

• superficial pain during sex – this symptom is expressed during the insertion of a penis and is often caused by pathologies of the labia or vestibule of the vagina;
• deep pain during sex - in such situations, pain is felt deep in the vagina or pelvic area. Most often, this is caused by a disease that affects the right or left ovary, as well as other deeply located genitourinary structures.

Symptoms

Pain may occur immediately before sexual intercourse, during the first penetration of the penis into the vaginal cavity, during its movements, or after completion of sexual intercourse.

The nature of the pain syndrome can be interpreted differently by each patient. Often women complain about:

1. burning or tingling.
2. discomfort.
3. sharp or sharp pain during sexual intercourse.

Due to the fact that such a symptom appears due to the occurrence in women gynecological pathologies, then this sign will be the first, but not the only clinical picture. Additional symptoms will include:

• itching and redness of the genitals;
• irradiation of pain to the lower abdomen, anal area, pelvis and sacrum, and pain in the lower back often occurs. With ovarian disease, there will be acute pain on the right or left, depending on which side the affected organ is located on;
• discharge of a cheesy consistency with an unpleasant odor;
• swelling of the labia majora and minora;
• the formation of small ulcers or blisters at the entrance to the vagina;
• discomfort during long periods of walking, sitting or cycling;
• menstrual irregularities - uterine bleeding is either scanty or excessively profuse, and also occurs ahead of schedule, for example, in the middle of the cycle;
• the presence of pathological impurities in urine;
• frequent urination;
• slight increase in temperature;
• weakness and malaise;
• loss of appetite and a sharp decrease in body weight - this indicates the formation of an oncological tumor.

It must be remembered that these are only the main symptoms, which will differ in one patient or another depending on the course of any illness.

“If pain occurs, discuss the problem with your partner and consult a doctor.”

Diagnostics

To find out the causes of pain during sexual intercourse, a comprehensive diagnostic approach is necessary. The first step of diagnosis is aimed at work gynecologist with the patient and includes the following activities:

1. familiarization with the medical history and life history of the woman - to determine which group of etiological factors the source of pain in a particular patient belongs to.
2. conducting a detailed gynecological examination, which includes palpation examination of the structure of the internal female genital organs, as well as the use of special mirrors and other instruments. This will allow us to identify the most characteristic signs of gynecological pathologies, for example, the presence of neoplasms or erosions, pain in the uterus or ovaries.
3. a thorough survey - to draw up a complete clinical picture and clarify the nature of pain.

Laboratory studies are limited to general clinical tests, which will show the presence of specific signs of a particular disease, as well as the level of female sex hormones. In some cases it may be required.

Instrumental diagnostics are based on the following procedures:

• diagnostic;
• MRI and MSCT.

In addition, the patient must be consulted with psychologist or psychotherapist. It is worth noting that in addition to the gynecologist, a sexologist can also perform diagnostics.

Treatment

Minor pain in the lower abdomen, which may intensify, is eliminated as the cause is eliminated. Given the fact that a large number of predisposing factors can lead to this, treatment tactics will also differ. For example:

1. during inflammatory processes, drug treatment is indicated, aimed at completely eliminating the disease;
2. if the reason that the ovaries, uterus or other internal genital organs hurt during sexual intercourse is due to neoplasms identified during instrumental diagnostics, then patients are prescribed a surgical operation aimed at excision of the tumor and the affected segment;
3. pain arising from psychological problems requires treatment from specialists such as a psychologist or sex therapist.

In any case, treatment will be individual.

Prevention and prognosis

In order to prevent painful sexual intercourse from disturbing female representatives, it is necessary:

• develop trusting relationships with your partner;
• engage in early diagnosis of gynecological ailments, which in their symptoms include sharp or acute pain during sex;
• get rid of psychological problems associated with intimate relationships;
• Visit your gynecologist regularly.

Separately, pain during sex does not threaten a woman’s life, but we should not forget that the diseases that cause them, if left untreated, can lead to the development of life-threatening complications.

One part of adult life is sexual relations, but in some cases there is discomfort that interferes with or prevents the ability to have sex.

In medicine, pain during sex is called dyspareunia. Such pain appears both inside and outside the genital organs. The article presents the reasons why the lower abdomen hurts during sex.

Pain not caused by disease

Often, during sexual intercourse, discomfort occurs in the lower abdomen for a banal reason - an incorrect and uncomfortable position. If this is the only problem, then don't worry.

In some cases, mechanical factors may be the cause:

1. Dry vaginal mucosa.
2. Vaginal tension.
3. Unstable emotional state.

Such factors are normal in some cases, and the lower abdomen may hurt during sex. Of course, in a person’s normal state and health, there should be no pain during sexual intercourse.

Women who use an intrauterine device may experience pain during sex, but in this case, menstruation is also painful.

When having sex, partners' genitals may not correspond, resulting in pain and discomfort. During sexual intercourse, the vagina is stretched, damaging the skin and mucous membrane.

Some people may have increased sensitivity to contraceptives and other elements that are used. Due to this, allergies and unpleasant symptoms in the lower abdomen occur.

For the reasons described, all you need to do is take a short break, change the means and types of contraceptives. The problem will go away the next time you have sex.

Causes triggered by diseases

If the lower abdomen hurts during sexual intercourse, then the cause may be a variety of diseases:

1. Vaginismus.
2. Inflammation.
3. Adhesive processes.
4. Endometriosis.
5. Venous stagnation of blood.

With vaginismus, women experience a strong spasm of the muscles in the vagina, which leads to pain, sometimes very severe.

A similar phenomenon exists among those people who were raped or whose upbringing did not involve engaging in sexual intercourse.

In this case, during sexual intercourse, a psychological change occurs and the muscles go into spasms.

Why does this happen? The whole reason is not penetration, but stress, which is caused by a psychological state.

Often such cases occur at a doctor’s appointment, when the patient is very tense and the doctor is not able to insert a mirror for examination. The same condition occurs during sex.

The cause of discomfort is spasm, which appears due to fear. You can get rid of this manifestation if you undergo therapy with a sexologist and psychologist. When the problem is not in an advanced form, the pathology will quickly cure.

During sexual intercourse, sensations arise in the form of itching, burning and pain in the lower abdomen, then you need to call a doctor for help.

Such symptoms indicate inflammation of the internal genital organs. In addition, it is recommended that not only the female gender, but also the partner go to the doctor.

During inflammatory processes, it is better not to have sex for the entire course of treatment or use condoms. Inflammation does not always mean that a partner is cheating.

The cause is the entry of staphylococcus or fungus from one’s own flora into an unusual environment. If your lower abdomen burns or itches during sex, it is better to get help from a doctor as soon as possible so that complications do not arise.

When a woman experiences pain in the lower abdomen during sex, there is no need to rule out a common occurrence such as adhesions in the pelvic area.

Pathology often appears if a woman has inflammation. The pain is characterized as constant, but can also be periodic.

According to research, many women have similar adhesions, but they are all in different forms and some do not even bother during intercourse.

If pain occurs due to adhesions, medical attention is needed. As a rule, treatment is carried out using physiotherapeutic methods and is considered the most effective therapy.

In more complex situations, surgical intervention is required.

After giving birth to a child, during sexual intercourse, in the first year after birth, the lower abdomen hurts. Discomfort is caused by postpartum injuries and rupture of sutures.

If you experience frequent pain in the lower abdomen during sex, with uncharacteristic discharge, and severe discomfort also appears during menstruation, the reason why this is so is endometriosis.

When a woman is ill, the lining of the uterus becomes inflamed, after which the inflammation spreads beyond it to other organs.

If treatment is not carried out, then sexual intercourse may not occur at all due to the inability to engage in it as a result of pain.

In such a situation, tumors can degenerate from benign to dangerous cancerous tumors.

Aching pain during sexual intercourse that radiates to the spine indicates venous stagnation of blood in the pelvic area. The problem can appear not only during sex, but also during menstruation.

Pathology appears as a result of various reasons:

1. Previously there were inflammations.
2. Many injuries were sustained during childbirth.
3. No orgasm during sex.
4. The lifestyle is sedentary or, on the contrary, heavy loads.

Such factors lead to muscle weakening, after which varicose veins appear.

If treatment is not carried out, the symptoms during sexual intercourse become stronger, after which uterine fibroids and other serious pathologies appear.

Sharp pain below during sex, which constantly intensifies and radiates to the leg, indicates neuralgia of the pelvic nerve.

This disease is rare in practice and has hardly been studied by doctors. In the advanced form of the disease, the pain is unbearable, even without sex.

In order for women to have an orgasm from each sex, a sufficient amount of lubricant is needed. When she does not appear, instead of pleasant things, the woman receives excruciating pain.

A visit to the gynecologist will help eliminate the problem, otherwise you can use gels or lubricants.

During defloration, the girl also has pain in her lower abdomen. Defloration is the deprivation of virginity.

This happens as a result of physiological characteristics and strong fear of first sex. Due to this, vaginal spasms appear, which causes pain.

The hymen does not cause pain or bleeding because it is very thin and elastic.

During the first sex, it stretches to the limit, after which it bursts. Very rarely it is dense and contains many nerve endings.

Psychological reasons

Sometimes the lower abdomen hurts during sexual intercourse due to psychological reasons. The main ones include:

1. Unpreparedness for sex and strong tension of the girl.
2. Consequences of trauma suffered at the psychological level (harassment, rape and other factors).
3. A discrepancy between the temperaments of the sexes, when a girl is naturally gentle and sophisticated, and a man wants a different behavior during sex. As a rule, sexual activity does not produce pleasant sensations or orgasm in women; only discomfort and pain appear.
4. Fears on a subconscious level. They happen if a woman is afraid of pregnancy or infection, in which case the body defends itself and the woman feels pain.

If any of the described causes are not addressed and treated, the consequences can be disastrous.

Often the pain turns into a chronic form, then women constantly have pain in the pelvic area, infertility appears and menstruation may be disrupted.

Treatment of pathologies is carried out differently, depending on why the pain appeared.

Initially, you should contact a gynecologist, and then the doctor, if necessary, will refer the patient to other doctors for examination. If the disease is serious and advanced, then surgical intervention is possible.

Useful video

Dyspareunia is the medical term for painful sensations that occur shortly before, during or after sex. Dyspareunia is most often observed during sexual intercourse, but sometimes pain appears before sex, or persists for hours or even days after intercourse.

Why does pain occur during sex?

There are several main causes of dyspareunia and we will look at each cause separately.

Beginning of sexual activity

It is not uncommon for young girls and women to experience pain during sex in the first few weeks or months after becoming sexually active.

Not only the first sex (deprivation), but also subsequent sexual acts can be painful. You can read about how to reduce pain during sex if you have just recently started having sex in the article:.

Physiological incompatibility of partners

A man's penis that is too large or a woman's vagina is too narrow can become an obstacle to a normal sex life. However, thanks to the physiological characteristics of the female body, this problem can be overcome. The thing is that the female vagina is very elastic, and over time it “adjusts” to almost any size of the male genital organ. In addition, the couple can choose positions for intercourse in which the woman herself can regulate the depth of penetration of the penis.

Insufficient lubrication

The lubricant that women produce during sexual arousal is designed to facilitate insertion of the penis and eliminate associated discomfort. The absence or insufficient amount of lubrication leads to pain during and after sexual intercourse.

Experts believe that the most common reason for poor lubrication production is the woman’s insufficient degree of sexual arousal at the time of sexual intercourse. Men often strive to begin sexual intercourse as soon as they achieve an erection, without paying due attention to whether their partner is ready for sex.

Increase the time allotted for foreplay, and do not begin sexual intercourse before you feel that you have enough lubrication. Another way out of this situation is to purchase artificial lubricant (lubricant) at a pharmacy or sex shop.

Inflammatory diseases

Inflammatory diseases of the genitourinary organs: inflammation of the vagina (colpitis), cervix (cervicitis), urethra (urethritis), bladder (), uterus (endometritis) and fallopian tubes (). Inflammation of each of these organs manifests itself differently.

The main warning signs indicating inflammation are: unpleasant odor, dryness and burning in the vagina, pain during urination, urinary incontinence, nagging pain in the lower abdomen and sides.

Inflammation can be caused by a variety of reasons: herpes virus, etc. Only your attending physician can clarify the cause of inflammation and prescribe treatment.

Ovarian cyst

Large ovarian cysts (more than 5 cm in diameter) often cause dull pain in the lower abdomen during exercise and sex. Pain associated with an ovarian cyst usually appears during deep penetration of the penis, and is aggravated in certain positions. You can detect an ovarian cyst using.

Endometriosis and adenomyosis

Endometriosis of the ovaries, fallopian tubes and other pelvic organs often leads to the formation of adhesions. Adhesions limit the mobility of internal organs and can cause pain during sex.

Pain usually appears during deep penetration of the penis and is aggravated in certain positions.

On our website there are separate articles devoted to these diseases: and

Uterine fibroids

Uterine fibroids are a benign tumor of the muscular layer of the uterus that can appear at almost any age.

Small uterine fibroids are usually asymptomatic and do not require any treatment. In some cases, fibroids can increase in size, leading to enlargement of the uterus, compression of surrounding organs and nerve fibers, and causing abdominal pain during sex.

Bend of the uterus

Abnormal position of the uterus in the pelvic cavity can cause pain during sex. When the uterus is bent, its apex is directed not anteriorly, as it should be normally, but posteriorly. Because of this, in certain positions with deep penetration, a woman may experience severe pain radiating to the sacrum.

There is an article on our website dedicated to this topic:.

Resuming sexual activity after childbirth

Many women complain of pain during sex in the first weeks or months after childbirth. The main cause of these pains is hormonal changes (lowering estrogen levels in the blood) and associated vaginal dryness.

Episiotomy (an incision in the perineum) during childbirth, as well as cracks and tears in the perineum during childbirth often lead to dyspareunia.

Some experts also note the role of emotional factors: the thoughts of young mothers are often occupied with a small child and are far from erotic fantasies.

Psychological factors

Psychological factors such as anxiety, depression, doubts about one's own sexual attractiveness, stress at work, misunderstandings in a couple, and previous sexual abuse (rape) can play an important role in the development of dyspareunia.

It has been noted that women who experience pain during sex more often complain of depressed mood, feelings of anxiety, dissatisfaction with their own lives, and more often than others feel unhappy.

In this case, only a psychologist or psychotherapist will help you cope with the problem of pain during sex.

Methods of contraception (condoms, OK, intrauterine device)

For some women, taking hormonal contraceptives (birth control pills) may cause pain during sex. In most cases, pain is caused by insufficient lubrication due to a decrease in estrogen levels in the blood. The use of artificial lubricant (lubricant) helps solve this problem in almost one hundred percent of cases.

Another common method of preventing pregnancy can also cause dyspareunia if it is not inserted correctly or falls out. If the IUD moves from the uterine cavity into the cervical canal, it can cause pain during sex. In this case, the spiral must be removed or replaced with a new one.

Vaginismus

Vaginismus is an involuntary contraction of the vaginal muscles in response to the insertion of foreign objects (for example, when inserting a penis or speculum). This involuntary muscle spasm can cause pain and discomfort during sexual intercourse.

The causes of vaginismus are still unknown, but most often this condition is associated with psychological problems. It has been noted that girls who have suffered sexual violence are much more likely to suffer from vaginismus. Vaginismus can also develop as a result of severe stress, fear, and anxiety.

In the treatment of vaginismus, they are used, which allow a woman to learn to control the muscles of the vagina. In some situations, you can only cope with the problem by contacting a psychologist or psychotherapist.

Operations and injuries

Previous operations on the pelvic organs, such as hysterectomy, removal of an ovarian cyst, surgery on the fallopian tubes, as well as fractures of the pelvic bones and injuries involving the pelvic bones in car accidents can cause pain during sex.

Treatment in each specific situation will be strictly individual, depending on the type of damage received.

Intimate relationships between a woman and a man are an important and integral part of a fulfilling life. Sex is important not only for obtaining physical satisfaction, but also for a feeling of psychological comfort. However, sexual relationships do not always bring pleasure, especially when the partner feels discomfort.

For women, a typical, frequent phenomenon is characteristic

painful sexual intercourse, in which they do not

can get the desired pleasure.

This has a bad effect on the psychological

status and personal relationships with a man.

Pain that occurs during sexual intercourse is called dyspareunia in medical terminology.. It can occur at any stage of sexual intercourse and does not depend on the woman’s age. Signs of the disease may vary in intensity, nature and location.

The cause of pain during sexual intercourse can be judged only after receiving all the results of the examination. Sometimes the causes of such pain are quite banal: incorrect body position, vaginal dryness, psychological discomfort next to an inexperienced partner.

Frequent manifestations of dyspareunia may indicate many diseases of the genitourinary or reproductive system that are of non-infectious or infectious origin.

Questions from the doctor when collecting anamnesis and establishing the cause of pain:

History taking

Are there other sexual disorders - decreased lubrication, lack of orgasm?

Have any treatment attempts been made?

Is there a discharge that has an unpleasant odor and changes in color?

Have sexually transmitted infections, including herpes and human papillomavirus, been previously discovered?

Have there been any surgeries on the abdominal or genitourinary organs, chemotherapy or radiation therapy?

Was there an aggravated obstetric history: birth with episiotromy, forceps, trauma?

History of chronic gynecological diseases to establish early diagnoses - chronic pelvic pain, uterine fibroids, endometriosis, salpingitis, etc.?

What contraception is used now and what was used previously (various intrauterine devices, diaphragms, caps, sponges, gels, foams?

Have any skin diseases been diagnosed - eczema, psoriasis, other dermatitis?

Are there any disturbances in the functioning of the urinary system - cystitis, urethritis, irritable bowel syndrome, colon diseases?

Do Behcet's syndrome and diabetes mellitus exist?

Is there increased sensitivity to topical products - ointments, creams, lotions, as well as intimate hygiene products - wet wipes, colored toilet paper?

Questions about the nature of the pain:

What kind of pain is deep during movement, before the act at the entrance or after the act?

If the pain is deep, then on which side is it localized: left, right or both sides?

Is there burning and itching?

Is the pain sharp, aching, severe or burning?

Does the nature of the pain depend on the chosen position?

Is the pain situational (occurs in certain situations or depends on the partner, does it depend on the menstrual cycle) or generalized (does not depend on the circumstances and partner)?

Has it appeared recently or has it been observed throughout your entire sexual life?

Are you addicted to alcohol or drugs?

Collection of psychosocial information

Have you had this problem during sexual intercourse with another partner?

Was the problem discussed with your partner?

Have any steps been taken to correct the problem?

Was there a history of rape or battery? Are there any other stressors?

Are you experiencing depression, anxiety, or other disorders?

Causes of dyspareunia

All the reasons that cause discomfort and pain during sexual intercourse can be clearly divided into 2 groups:

Diseases of the urinary system or genital area of ​​non-infectious and infectious nature.

Psychological factors associated with fear of pain after unsuccessful sexual intercourse.

Before establishing the true cause, it is necessary to make sure whether the woman has sufficient sexual arousal before the act. Typically, insufficient arousal is observed when there is a conflict between partners, instability in relationships, or a lack of technique in foreplay and games. Unfortunately, very quickly psychological aspects are attached to all this. And if at first insufficient lubrication occurs only with inadequate sex technique, then later this condition repeats and becomes expected during sexual intercourse.

Diseases manifested by pain during sexual intercourse

Pain during sex can be a symptom of a variety of pathological conditions, have different etiologies and occur in different parts of the anatomical genital area.

Infectious diseases:

Endometriosis is a pathological disease of the uterine mucosa, in which particles of the mucous membrane are found in uncharacteristic places: the serous and muscular layer of the uterus, in the peritoneum, ovaries and walls of internal organs.

Vaginitis is an acute or chronic inflammatory process in the vagina. The causative agents of the disease are fungi, mycoplasmas, trichomonas, gonococci, chlamydia and pathogenic nonspecific microorganisms. Often the disease can appear against the background of repeated hormonal disorders.

Cystitis is an inflammatory process in the bladder.

Urethritis is an inflammation of the tissues of the urethra.

Cervicitis and inflammation of the appendages (salpingitis, chronic endometritis).

Adhesive disease in the pelvis develops after a previous history of chronic or acute inflammation in the abdominal cavity.

Body conditions and non-communicable diseases:

Injuries, postpartum ruptures and postoperative sutures.

Insufficient lubrication - in young women it is caused by inactivity of the arousal phase, in women in menopause - by a lack of estrogen.

Venous stagnation - occurs when there is complete abstinence from sex or irregular intimate contacts, when blood stagnates in the vessels of the pelvic organs.

Retroversion of the uterus (posterior deviation, bending of the uterus) is an abnormal location of the uterus in relation to the rest of the pelvic organs.

Vaginal atrophy - observed most often during menopause after menstruation stops, is dryness of the vaginal mucosa against the background of a constant lack of sex hormones estrogen.

Cysts and fibroids are malignant and benign tumors localized on the reproductive organs in the pelvis.

Weakening the tone of the lower part of the pelvis leads to prolapse of the uterus.

Size discrepancy or anatomical incompatibility is a fairly rare occurrence, because the vagina is highly extensible, and apart from clinical gigantism in a man, pain during sex with normal lubrication in a woman should not be alarmed by the discrepancy in size.

How does dyspareunia manifest?

Dyspareunia can occur before the onset of sexual intercourse, at the moment of the first penetration of the male member into the vagina and its forward movements, as well as after completion of sexual intercourse. Depending on the individual characteristics of each woman, painful sensations can take on various forms: sharp or acute pain, tingling, discomfort, and sometimes burning.

Chronic pain of moderate and low intensity is characteristic of diseases of non-infectious origin. If sharp pain is observed during sexual intercourse, this may indicate an acute inflammatory pathology of the uterus, appendages and ovaries.

When psychological factors become the cause of painful sensations, the pain can have varying intensity and localization, and also disappear without a trace when changing the sexual partner or environment.

• Superficial pain at the entrance

The occurrence of pain at the beginning of sex can be a complication of various diseases of the lips and vestibule, and can be combined with insufficient arousal or hydration and vaginismus. Also, if pain is observed at the beginning of sexual intercourse, this may indicate the development of fungal or bacterial vaginitis, mucosal atrophy, vulvodydia or vulvorous dystrophy that occurs against the background of genital herpes. During a gynecological examination, the doctor may notice ulcers and fissures in the vestibule of the vagina. After successful treatment of an infectious disease in the presence of herpetic eruptions, the pain is eliminated. Pain during palpation along the urethra and bladder indicates urethritis of various origins.

• Deep pains

Women describe deep painful sensations during sexual intercourse “as if something is being driven inside.” Their most common cause is adhesions, stagnation of blood in the pelvis, endometriosis, less often endometritis and inflammation of the appendages, even less often retroversion (abnormal location) of the uterus and weakening of the tone of the pelvic floor.

Diseases of the urinary system, in addition to the main symptoms (cutting, pain and burning during urination), are complemented by pain during sex.

The same applies to intestinal diseases - inflammation of the colon, irritable bowel syndrome, etc. tend to be accompanied by pain during intimacy.

In women of menopausal age, dryness in the vagina, insufficient arousal phase and atrophic changes make it difficult to move the penis, causing pain inside and at the entrance. Thus, the vaginal cavity does not lengthen or expand in response to arousal; the pain intensifies and becomes very strong with pressure from the penis on the cervix or certain positions.

Depending on the location of the pain, it can be triggered by the following reasons:

At the entrance to the vagina	Deep pain	And at the entrance, and deep pain
Insufficient hydration and stimulation Vulvar vestibulitis Colpitis (vaginitis) Vaginismus Vulvodynia Urethritis	Chronic cervicitis Venous stagnation of blood in the pelvis Retroversion of the uterus Pathology of the urethra and appendages Endometritis and inflammatory processes in the pelvis Endometriosis Adhesions in the pelvis	Sjögren's syndrome Vaginal dryness (vaginal atrophy) Insufficient lubrication After surgery, trauma and childbirth

• Pain during intercourse after pregnancy

The nature of the origin of postpartum pain remains unclear. According to one study, pain in 40% of patients was non-localized, 45% of women had pain at the entrance, in the places where the tears were stitched. Moreover, based on the patients’ complaints, they did not depend on whether it was the first birth or not. Six months after childbirth, non-localized pain is eliminated; in some cases, pain persists for a year.

Psychological causes of pain

In addition to gynecological diseases that contribute to the development of dyspareunia, this process can also occur at a subconscious level when, for some psychological reason, a woman refuses sexual intercourse.

• Fear of sexual intercourse

Defloration, characterized by a feeling of fear of intimacy, is considered a common cause of pain. During defloration, pain occurs due to tearing of the hymen during the first sexual intercourse. The cause of this violation may be fear of a partner, fear of pregnancy, cruelty on the part of a partner, lack of love and other factors that prevent a woman from relaxing. In many ways, a woman’s condition during sexual intercourse depends on the behavior of her partner, but she can only overcome the fear of defloration herself. If you cannot do this on your own, it is recommended to consult a professional psychologist or sexologist for help.

• Vaginismus

The cause of pain can also be vaginismus, a condition that is often observed as a complication of defloration, when a woman cannot overcome her fears associated with an unsuccessful sexual experience for a long period of time. With vaginismus, uncontrolled and involuntary, sharp painful spasms of the vaginal muscles are observed, which is why it is impossible to complete full sexual intercourse.

• Pain during pregnancy during intimacy

Some women feel pain during sex during pregnancy. This condition most often occurs at the level of the subcortical centers of the brain. A woman fears that penetration of the penis into the vagina will cause pregnancy complications or harm the fetus. Most doctors believe that dyspareunia is a condition characteristic of gynecological diseases and is not directly related to pregnancy.

• Uncertainty about one's sexuality and oneself, an inferiority complex

Often, a tendency to be overweight, figure flaws and other physical defects lead to a woman’s complexes. She has thoughts about her unattractiveness and non-sexuality in the eyes of her partner. Of course, this has a characteristic effect on a woman’s sexual life and can cause an inferior phase of arousal and pain during sexual intercourse.

Diagnostic methods

The causes of dyspareunia can be determined by visiting a psychotherapist, sexologist, urologist or gynecologist. At the first stage of diagnosis, the specialist collects the patient’s medical history, in which the woman describes the main symptoms, complaints and conditions for the occurrence of pain. If a patient is suspected of having gynecological diseases, she may be referred for diagnostic and laboratory tests:

Detailed or general clinical urine and blood tests.

Examination using ultrasound of the pelvic organs.

Examination for the presence of infections, including those transmitted through sexual contact without barrier contraception.

Based on examinations, the doctor will be able to refute or confirm the organic nature of dyspareunia associated with a specific disease. If the cause of the painful condition cannot be found, then we are talking about its psychological origin.

Differentiation of disorders that cause pain during sex:

Diagnosis	Symptoms	Causes	Research data	Assessment of further actions
Dyspareunia of unknown origin	Deep pain or pain at the beginning of sex	Unknown	No signs of other disorders were identified	Psychological examination required
Pain in the vulva (vulvodynia)	Complaints about irritation at the entrance, burning, lack of positive effect from treatment, pain in a sitting position and while riding a bicycle (when pressing on the vulva)	Irritants, infections, or unexplained pain	There is erythema or no changes on the skin, pain on palpation. If pigmentation, ulcers or nodules are present, you need to look for another pathology	A thorough examination, colposcopy, biopsy of suspicious areas, application of acetic acid to open areas
Vulvar vestibulitis (a type of vulvodynia)	Dull aching pain, itching, burning, inflammation of the vestibular region of the vulva, pain at the entrance	Unknown	Flat erythema without the presence of ulcers, with blurred or clear edges, sharp pain is observed when touched with a cotton swab
Vaginismus	Difficulty inserting a tampon, finger, penis, pain at the entrance, muscle spasm at the entrance to the vagina	Unknown, reflexive reaction of muscles or psychological reasons	On palpation, vaginal spasm is observed, difficulty inserting a speculum	A physical and psychological examination and the patient’s medical history are important.
tissue atrophy, disruption of natural hydration during arousal	Difficulty and pain when inserting the penis, friction, irritation, vaginal dryness	Stretching and decreased natural lubrication of the vagina, estrogen deficiency, problems with the onset of arousal surgical intervention	During examination, special attention is paid to the integrity of the mucous membrane, the fullness of the labia, the presence of cracks, identifying the level of ease of injury to the mucous membrane, the presence of pubic baldness	Discuss the meaning of foreplay, sensations during arousal
Adhesions, endometriosis of the uterus	Deep pain, painful sensations of menstrual origin	In case of adhesions, the causes are infectious diseases, surgical intervention; in case of endometriosis, the reasons are unclear.	The uterus and appendages are inactive, the presence of nodules is observed	Laparoscopy
Diseases of the uterine appendages	Deep pain, often localized only to the left or right	Ovarian cyst, sexually transmitted infections	Appendages are painful, enlarged, inactive	Laparoscopy
Abnormal placement of the uterus, weakened pelvic floor tone, uterine fibroids	Deep pain	Special anatomical placement of the uterus	Prolapse or enlargement of the uterus	Try to change positions during sexual intercourse (position - woman on top)
Venous stagnation	Deep pain, pain after sexual intercourse in the pelvis	It is unknown whether women with varicose veins are at increased risk of developing varicose veins.	Without features	According to the characteristics of pain
Interstitial cystitis, urethritis, cystitis	Feeling of pressure above the pubis, increased urge to urinate	Unclear etiology and infections	Pain on palpation of the urethra and bladder	General urine test, urine culture tank
Chronic cervicitis, pelvic inflammatory disease, endometritis	Deep pain	Infections	Pain when the cervix is ​​displaced, the cervix is ​​easily injured, the uterus is painful, the presence of discharge	Laparoscopy, colposcopy, tests for infections, bacterial culture

Treatment of dyspareunia

Treatment of discomfort and pain during sexual intercourse is determined depending on the reasons that provoked their occurrence. If the cause of dyspareunia lies in inflammatory processes, drug treatment is prescribed aimed at eliminating the source of the disease. For diseases such as ovarian cysts or fibroids, endometriosis, surgical intervention is often prescribed. Dyspareunia, which occurs on a psychological level, is treated in consultation with a psychologist or sex therapist.

Systematically repeated painful sexual intercourse should not be ignored, and self-medication is not recommended. Only an experienced and qualified doctor will be able to find the cause of pain during sexual intercourse, carry out effective treatment and give the woman effective recommendations for returning to a comfortable and fulfilling sex life.

Referring to the huge variety and number of reasons that contribute to the development of dyspareunia, every woman should understand that this condition cannot be neglected and wait for pain during intimacy to go away on its own. The sooner a woman turns to a doctor for help, the more effective it will be to eliminate the factor that caused this pathological condition and the faster the treatment will be completed.