Understanding Pain during Sexual Intercourse – Common Causes

Intimate togetherness holds great significance for many individuals, whether within or outside relationships. It is no surprise that renowned American psychologist Abraham Maslow integrated sexuality into his well-known Maslow’s Pyramid of Needs. However, the sad reality is that not everyone can fully enjoy the pleasures of sex, often due to the presence of pain during sexual intercourse – a condition known as dyspareunia.

Today, we embark on a journey to delve into the underlying reasons behind this distressing issue. We will explore the myriad of causes contributing to dyspareunia while shedding light on its close association with endometriosis.

Understanding the Prevalence of Pain during Sexual Intercourse

Intimate togetherness is a topic that has become more openly discussed in recent times, encompassing aspects such as favorite positions and sex toys. However, one aspect that remains largely taboo is the occurrence of pain during sexual intercourse. The fear of facing this issue alone can be overwhelming. Yet, studies indicate that dyspareunia, as it is medically known, is far more common than previously thought.

In an enlightening American study, researchers analyzed data from 1,738 women and men collected through the 2012 National Survey of Sexual Health Behavior – a comprehensive Internet-based survey representative of Americans.

The result: The findings revealed that approximately 30% of women reported experiencing pain during vaginal intercourse. In most instances, these pains were mild and of short duration [1]. However, for some individuals, pain during intercourse can be a persistent companion. The German Professional Association of Gynecologists (BVF) estimates that about 10% of women endure pain during sexual activity [2].

Good to know!

Pain during sexual intercourse is not the same for everyone. Some women may experience pain around the vaginal opening, while others may feel it deep in the pelvis. Reports from women often describe sensations of burning, cramping, or stabbing.

Understanding the Causes of Pain during Sexual Intercourse

Sex, an act that should ideally be pleasurable and delightful, can sometimes be accompanied by pain due to various reasons. To gain a better understanding, we can differentiate between superficial and deep-seated pain.

Reasons for Superficial Pain

Have you ever heard of the “Bartholin’s glands”? These are two glands located in the vaginal vestibule responsible for secreting that provides lubrication during sexual arousal. Insufficient foreplay can result in inadequate vaginal moistening, leading to discomfort during intercourse. Vaginal dryness may also be caused by declining estrogen levels, such as during menopause or pregnancy.

Apart from insufficient lubrication, superficial pain may also be caused by:

  • Increased sensitivity to pain in the genital area, known as vulvar vestibulitis or provoked vestibulodynia.
  • Urinary tract infections or sexually transmitted diseases.
  • Allergic reactions to contraceptives.
  • Involuntary spasm of the pelvic floor muscles, referred to as vaginismus.
  • Congenital characteristics, such as an abnormally formed vaginal partition wall.
  • Scarring after vaginal surgery, such as tissue repair following childbirth.

If persistent pain is experienced, it is important to discuss the issue with a doctor to explore possible causes and treatment options.

Reasons for Deep-Seated Pain

Deep-seated pain during intercourse may originate further inside the body. Women with endometriosis often describe this type of pain, particularly during deep penetrations. Studies suggest that between 10 and 50% of endometriosis experience this issue [3].

Deep-seated pain during sexual intercourse may also be an indication of the following medical conditions:

  • Abscesses caused by infection of the fallopian tubes, uterus, or cervix
  • Ovarian cysts.
  • Tumors in the pelvic cavity.
  • Scarring between pelvic organs caused by infections, surgery, or radiation therapy
  • Pelvic muscle hypertension (involuntary muscle tension in the pelvic area).
  • Retroversion of the uterus (uterus tilted backward)

It is crucial that individuals experiencing persistent pain discuss their symptoms with a doctor promptly.

Good to know!

Pain during sexual intercourse is not always attributed to physical causes, it can also be an indicator of emotional or psychological factors, such as anxiety or trauma.

Dyspareunia in Endometriosis

In endometriosis, a condition where endometrial tissue settles outside the uterus, various distressing symptoms can manifest. Among the leading symptoms is dyspareunia, which refers to pain during sexual intercourse.[4]

The pain experienced during intercourse in endometriosis may result from pressure applied to the endometriosis lesions. Additionally, adhesions to sensitive organs can trigger discomfort. Moreover, women often exhibit increased tension in the pelvic floor muscles, which can also contribute to pain during intercourse, and in some cases, even during or after orgasm. In such situations, seeking the expertise of a physiotherapist is recommended.

Dyspareunia in endometriosis is frequently associated with specific findings, including:

  • Endometriosis lesions in the Douglas space (between the rectum and uterus) [5].
  • Endometriosis in the intestine [5].
  • Endometriosis lesions in the vagina [5].
  • Endometriosis on the uterine ligaments [5].
  • Endometriosis lesions on the ovary [5].
  • Ovarian endometriosis [5].

Research suggests that pain during sexual intercourse is more prevalent in individuals experiencing chronic lower abdominal pain and increased pain sensitivity (hyperalgesia) [5].

Painful Sexual Intercourse: How Do Doctors Diagnose?

Experiencing pain during or after sexual intercourse warrants a visit to your gynecologist, who can provide valuable insight and guidance. During your appointment, your medical history will be thoroughly discussed. Your doctor will inquire about the intensity and nature of the pain, such as whether it feels like burning or cramping.

Discovering any pre-existing medical conditions or past surgeries is crucial in the diagnostic process. Besides assessing physical symptoms and overall health, your doctor will also consider psychological and social factors.

Variables like stress levels, relationship dynamics, and emotional well-being play significant roles in understanding the issue. Engaging in a trusting and informative conversation with your medical professional will aid in exploring potential causes for the pain.

Following the discussion, a physical examination will be conducted. If necessary, the doctor may take samples for laboratory analysis, such as a smear test, to rule out any infectious diseases.

Good to know!

If the physician identifies potential indicators that endometriosis may be the underlying cause of pain during sexual intercourse, further tests will be conducted. To delve deeper into the matter, the doctor may schedule a vaginal or abdominal ultrasound.

Please note: It is essential to note that not all endometriosis lesions can be detected through ultrasound alone. In cases where additional information is required, your doctor may recommend an abdominal endoscopy for a more comprehensive evaluation.

Pain during Sex: Exploring Treatment Options

Firstly, it is essential to know that you do not have to endure pain during sexual intercourse. There are numerous therapies available that take into account your overall health and potential causes of the discomfort. Depending on the underlying physical condition, medications such as antibiotics or hormone preparations might be considered. In certain cases, surgical interventions may also be necessary, based on the diagnosis. For individuals diagnosed with endometriosis, the gynecologist will provide detailed advice on the most suitable treatment approach. Often, the removal of endometriosis lesions can help alleviate the symptoms.

Sex Counseling for Endometriosis?

Endometriosis can significantly impact one’s sex life, as it involves a multi-faceted togetherness that extends beyond mere functionality. Research indicates an interplay between sexual dysfunction and pain intensity. Moreover, partner satisfaction is frequently cited as the primary motivation for engaging in sexual intercourse. [6] The fact that endometriosis can negatively affect the quality of the sexual relationship was also evidenced by another study [3],

The Problem: Women rarely receive counseling to maintain a fulfilling sex life after their endometriosis diagnosis [6, 7].

Potential Solutions: A multidisciplinary approach may offer a way forward, involving sexologists, physiotherapists, psychologists, or psychotherapists in addition to gynecologists. This team can provide support in communication with partners, addressing individual complaints, and exploring needs. Open communication with partners can lead to identifying pleasurable activities in the sexual realm and can help not only to reduce pain during intercourse but also to enhance the overall sexual experience for endometriosis patients [1].

In addition, exploring one’s sexuality in a relaxed manner through masturbation can be helpful in discovering what is pleasurable and what may cause discomfort.

A Few Tips for a Fulfilling Love Life with Endometriosis

Living with endometriosis does not mean sacrificing a satisfying love life. By following a few tips, you can help prevent pain during sexual intercourse and foster a positive intimate experience:

Important: If you experience persistent or severe pain during sexual intercourse, we strongly advise you to make an appointment with your gynecologist immediately.

  1. Communicate with Your Partner: Pain during sex should not be a taboo topic. Engage in open and honest discussions with your partner about what feels pleasant and what causes pain or discomfort.
  2. Find the Right Position: Dyspareunia is more common in individuals with endometriosis (occurring ten times more often than in women without this condition), particularly with deep penetration [9, 10]. Experiment with various positions to find the ones that offer the most comfort and enjoyment for both partners.
  3. Perform Pelvic Floor Exercises: Pelvic floor tension is common in women with endometriosis, leading to trigger points that cause pain during intercourse [11]. Practice pelvic floor relaxation exercises to ease tension and promote relaxation in the area.
  4. Prioritize Sensitive Foreplay: Extensive foreplay can reduce anxiety about the pain and increase vaginal lubrication, making intercourse more comfortable. It can also trigger the production of natural pain-relieving substances in the body.
  5. Explore Alternative Sexual Experiences: Remember that sex is not solely about penetration. Explore different ways to arouse each other and experience intimacy. Consider trying new activities together to enhance your emotional connection.
  6. Track your Discomfort: Keep track of your discomfort to identify patterns and changes that impact your love life positively. Using tools like our endometriosis app can help you monitor and manage your symptoms effectively.

In a Nutshell

Sexuality is a fundamental aspect of our lives, but pain during sexual intercourse can hinder the pleasure it brings. Various factors can contribute to this discomfort, such as infections, allergic reactions, or scarring. For women with endometriosis, pain during sex is a common concern, affecting up to 50% of those with endometriosis lesions. To identify the reasons for painful intercourse, your doctor will inquire about physical symptoms and consider psychological factors, like past trauma or relationship dynamics.

After a thorough consultation, a physical examination and diagnostic tests, such as ultrasound or lab tests, may be conducted to reach a specific diagnosis. If diagnosed with endometriosis, hormone therapy or surgery may be recommended, and for many women, the removal of endometriosis lesions can significantly improve symptoms.

Regular communication with your partner is vital in finding ways to prevent pain during intercourse, such as exploring suitable positions or engaging in extensive foreplay. Seeking sex counseling can also offer valuable insights for a fulfilling and enjoyable sex life despite endometriosis-related challenges.

References

  1. Herbenick D, Schick V, Sanders SA, Reece M, Fortenberry JD. Pain experienced during vaginal and anal intercourse with other-sex partners: findings from a nationally representative probability study in the United States. J Sex Med. 2015 Apr;12(4):1040-51. doi: 10.1111/jsm.12841. Epub 2015 Feb 4. PMID: 25648245.
  2. Berufsverband der Frauenärzte e.V. (BVF): Sexualstörungen. Zuletzt abgerufen am 20.01.2022.
  3. Pluchino N, Wenger JM, Petignat P, Tal R, Bolmont M, Taylor HS, Bianchi-Demicheli F. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update. 2016 Nov;22(6):762-774. doi: 10.1093/humupd/dmw031. Epub 2016 Sep 2. PMID: 27591248.
  4. Diedrich, Klaus. Gynäkologie und Geburtshilfe (Springer-Lehrbuch) (German Edition) (S.303). Springer Berlin Heidelberg. Kindle-Version.
  5. Jahrestagung der Endometriose Vereinigung: Sexualität bei Endometriose, 2017
  6. Fritzer N, Haas D, Oppelt P, Renner S, Hornung D, Wölfler M, Ulrich U, Fischerlehner G, Sillem M, Hudelist G. More than just bad sex: sexual dysfunction and distress in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):392-6. doi: 10.1016/j.ejogrb.2013.04.001. Epub 2013 May 1. PMID: 23642970.
  7. Di Donato N, Montanari G, Benfenati A, Monti G, Bertoldo V, Mauloni M, Seracchioli R. Do women with endometriosis have to worry about sex? Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:69-74. doi: 10.1016/j.ejogrb.2014.05.022. Epub 2014 Jun 2. PMID: 24965983.
  8. Barbara G, Facchin F, Meschia M, Berlanda N, Frattaruolo MP, VercellinI P. When love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning. Acta Obstet Gynecol Scand. 2017 Jun;96(6):668-687. doi: 10.1111/aogs.13031. Epub 2016 Nov 5. PMID: 27687240.
  9. Denny E, Mann CH. Endometriosis-associated dyspareunia: the impact on women’s lives. J Fam Plann Reprod Health Care. 2007 Jul;33(3):189-93. doi: 10.1783/147118907781004831. PMID: 17609078.
  10. Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study–Part 1. BJOG. 2008 Oct;115(11):1382-91. doi: 10.1111/j.1471-0528.2008.01878.x. Epub 2008 Aug 19. PMID: 18715240.
  11. Yong PJ, Mui J, Allaire C, Williams C. Pelvic floor tenderness in the etiology of superficial dyspareunia. J Obstet Gynaecol Can. 2014 Nov;36(11):1002-1009. doi: 10.1016/S1701-2163(15)30414-X. PMID: 25574678.
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Dipl.-Ges.oec. Jennifer Ann Steinort
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