Causes and treatment for pain during sexual intercourse
Pain is not normal during sexual intercourse and women should not simply endure it. It is necessary to study why it occurs.
There are various causes of pain during sexual intercourse, which we will describe below.
Bleeding and pain during intercourse
Normally, bleeding and pain during sexual intercourse is usually caused by vaginal dryness. In general, there is no bleeding in the early stages of dryness, but when it is more advanced, there is; therefore, it is advisable to stop it in time so that it does not reach that stage.
There are also other causes of bleeding related to the cervix and deep penetration, but these do not cause pain.
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Bleeding and pain during intercourse
Normally, bleeding and pain during sexual intercourse is usually caused by vaginal dryness. In general, there is no bleeding in the early stages of dryness, but when it is more advanced, there is; therefore, it is advisable to stop it in time so that it does not reach that stage.
There are also other causes of bleeding related to the cervix and deep penetration, but these do not cause pain.
Causes of vulvar pain and dryness
When we talk about pain during sexual intercourse, we initially think that the cause is vulvar dryness, but there may also be other factors that cause it, such as:
1. Changes in the vaginal flora
2. Vaginal spasms or contractions (vaginismus)
3. Alteration of sensitivity in the area.
It is very important to carry out a thorough assessment to determine the cause and focus treatment on eliminating the pain.
Vaginal dryness
The main cause of pain, and the most common, as mentioned above, is vulvovaginal dryness. We refer to it as vulvovaginal because dryness affects both the vagina and the vulva, acting as a whole.
Vaginal dryness occurs due to various circumstances, such as:
1. Loss of oestrogen during various stages of life.
2. Menopause
3. Treatments for breast cancer
4. Prolonged breastfeeding
5. Hormonal contraceptives
Vaginismus
Vaginismus is the involuntary contraction of the muscles of the vagina, in other words, when a woman is unable to control the contraction. There are two types of vaginismus:
1. Primary vaginismus: occurs during the first attempts at sexual intercourse because penetration has never happened before. It is a phobia and is treated as such through sex therapy, although in severe cases it may be helpful to use some form of treatment to relax the muscles.
2. Secondary vaginismus: this is a reaction to pain. If we compare it to an example from everyday life, it could be when you put your hand in the fire and your body contracts the muscles in your arm to pull it away. The same thing happens with the vagina when there is vaginal pain, usually at the entrance, which unintentionally contracts and reacts to the pain. At first, that pain is just a nuisance and causes muscle tension, which makes it hurt more, but there comes a point when the brain says it does not want to be exposed to that pain, so the muscle tension is so great that no matter how hard you try, you cannot do it.
To treat vaginismus, this muscle must be worked on with pelvic floor physiotherapy to improve contracture and relax the muscles. In more advanced cases, substances can be injected to induce muscle relaxation.
Dyspareunia
Dyspareunia is the medical term for painful sexual intercourse. It is synonymous with coital pain and is an all-encompassing generic name.
That pain can be of two types:
1. At the entrance to the vagina, which prevents penetration and therefore prevents satisfactory sexual intercourse.
2. During deep penetration, which can be caused by endometriosis (a genital tract disease that causes pain during menstruation) or by the position of the uterus, which when facing backwards and certain sexual positions are performed (it also depends on the size of the penis), can cause pain during deep penetration. In addition, it may also hurt after giving birth because internal changes have occurred.
Skin infections
A vaginal infection can cause painful sexual intercourse because the infection can compromise vaginal mucosa, and vaginal inflammation caused by infection will result in pain during sexual intercourse.
To treat skin infections:
1. First, treatment to clear up the infection is advisable.
2. The next step entails restoring the normal, healthy vaginal flora.
3. After these first two steps, sexual intercourse should now be painless because everything has returned to normal.
Postpartum recovery
In many cases, sexual intercourse after childbirth causes pain, and this may be because there is less lubrication due to several factors:
1. Breastfeeding: prolactin, the hormone that produces milk, causes oestrogen levels to drop, leading to vaginal dryness and pain during intercourse.
2. After giving birth, women are tired and their number one priority is the baby, not their partner, so they have less sexual desire and, in turn, less lubrication, which leads to pain.
3. Fear of pain may arise during sexual intercourse because the scar area (whether from a caesarean section or episiotomy) remains tense and there may be pain in the scar. This is resolved by applying infiltrations when necessary.
It is important to note that pain during sexual intercourse is not normal, even after childbirth, so if you experience it, it is advisable to consult a specialist to put an end to it.
If the pain is not treated from the outset, a vicious circle can ensue, since when a woman experiences coital pain, she is more likely to expect sexual intercourse to hurt, and thus become less aroused. At the slightest pain, her vagina may close up, which increases the pain, feeding into a vicious circle and ultimately resulting in sexual avoidance.
Treating burning and pain during penetration
The burning and pain we feel during penetration are often associated with vaginal dryness and can be treated with regenerative medicine:
Laser
Radiofrequency
Infiltrations at the entrance to the vagina
Surgical treatments
Surgical treatments to address burning and pain during sexual intercourse are the last resort for eliminating this pain. They are used when medical or regenerative treatments are not effective and surgery is required.
Hormone therapy
Hormone treatments are the ones that have been used throughout history and are the most scientifically accepted. Vaginal dryness and pain during intercourse are caused by a lack of oestrogen, so if we are deficient, we take it to compensate. The main drawback of local hormone treatments is the potential for non-adherence, as they involve using a local vaginal treatment (cream, tablets, etc.) for the rest of one's life. At first, we are always very motivated and it is easy to follow the treatment, but as time passes and the pain and burning sensation improve, we stop the treatment and all the symptoms return and worsen.
Laser treatments
In gynaecology, lasers have been used for around 10 to 12 years and are a physical method used for regeneration. It helps the skin to regenerate, thereby restoring the vaginal mucosa. So how does it work? The treatment involves creating very small and painless micro-burns that cause the tissue around the burn to regenerate, thus restoring the tissue to how it was before the onset of menopause or vaginal dryness.
Expert opinion
Painful sexual intercourse IS NOT NORMAL. But it is also true that, in most cases, it is caused by biological factors which, if not treated properly, will cause it to persist and worsen over time. When there is pain, all phases of the sexual response are affected, including desire. To solve this problem, it is essential to take a comprehensive approach from all angles: physical (the mucous membrane, skin and muscles), psychological (how you feel and how it affects you individually) and relational (how it is affecting your partner and your relationship).
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