If you have frequent or severe pain during $*X, you should see a health care provider. It is important to rule out gynecologic conditions that may be causing your pain. Your health care provider also can help you address problems with $*Xual response.
What causes $*Xual response problems?
The following reasons are among the most common:
Your state of mind—Emotions such as fear, guilt, shame, embarrassment, or awkwardness about having $*X may make it hard to relax. When you cannot relax, arousal is difficult, and pain may result. Stress and fatigue can affect your desire to have $*X.
Relationship problems—Problems with your partner may interfere with your $*Xual response. A common relationship issue is a mismatch between partners in their level of desire for $*X.
Medications—Many medications can reduce $*Xual desire, including some birth control methods. Many pain medications also can reduce $*Xual de'sire.
Medical and surgical conditions—Some medical conditions can indirectly affect $*Xual response. These conditions include arthritis, diabetes, cancer, and thyroid conditions. Some women who have had surgery find that it affects their body image, which may decrease their desire for $*X.
Your partner—If your partner has a $*Xual problem, it can make you anxious about $*X. If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, which can cause long, painful intercourse.
What kinds of gynecologic conditions can cause pain during $*X?
Pain during $*Xual intercourse can be a warning sign of many gynecologic conditions. Some of these conditions can lead to other problems if not treated:
Skin disorders—Some skin disorders may result in ulcers or cracks in the skin of the vulva. Contact dermatitis is a common skin disorder that affects the vulva. It is a reaction to an irritating substance, such as perfumed soaps, douches, or lubricants. It may cause itching, burning, and pain. Treatment of skin disorders depends on the type of disorder.
Vulvodynia—This is a pain disorder that affects the vulva. When pain is confined to the vestibule (the area around the opening of the v@g!na), it is known as vulvar vestibulitis syndrome (VVS). There are many treatments available for vulvodynia, including self-care measures. Medication or surgery may be needed in some cases. For more information about this condition, see the FAQ Vulfvodynia.
Hormonal changes—During perimenopause and menopause, decreasing levels of the female hormone estrogen may cause v@g!nal dryness. Hormone therapy is one treatment option. Using a lubricant during $*X or a v@g!nal moisturizer also may be helpful.
Vaginitis—Vaginitis, or inflammation of the v@g!na, can be caused by a yeast or bacterial infection. Symptoms are discharge and itching and burning of the v@g!na and vulva. Vaginitis can be treated with medication Vagini'smus—Vagini'smus is a reflex contraction (tightening) of the muscles at the opening of your v@g!na. Vaginismus may cause pain when you try to have $*Xual intercourse. Vaginismus can be treated with different forms of therapy.
Childbirth—Women who have had an episiotomy or tears in the perineum during childbirth may have pain during $*X that may last for several months. Treatments include physical therapy, medications, or surgery.
Other causes—Pelvic inflammatory disease, endometriosis, and adhesions are all associated with pain during $*X.
What can I expect when I see my health care provider about pain during $*X?
Your medical and $*Xual history, signs and symptoms, and findings from a physical exam are important factors in determining the cause of your pain. Sometimes, tests are needed to find the cause. A pelvic exam or ultrasound exam often gives clues about the causes of some kinds of pain. Further evaluation, sometimes involving a procedure called a laparoscopy, may be needed.
You also may be asked about medications that you are taking, whether you have any medical conditions, and past events that may affect how you feel about $*X, such as $*Xual abuse. Other health care providers may be consulted for further evaluation and treatment, such as a physical therapist or a dermatologist (a specialist in diseases of the skin).
Are there things a woman can do on her own to help with pain during $*X?
If you have pain during $*X, see a health care provider. However, there are some self-help measures you can try to relieve pain during $*X:
Use a lubricant. Water-soluble lubricants are a good choice if you experience v@g!nal irritation or sensitivity. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.
Make time for $*X. Set aside a time when neither you nor your partner is tired or anxious.
Talk to your partner. Tell your partner where and when you feel pain, as well as what activities you find pleasurable.
Try $*Xual activities that do not cause pain. For example, if intercourse is painful, you and your partner may want to focus on oral $*X or mutual masturbation.
Try non$*Xual, but sensual, activities like massage.
Take pain-relieving steps before $*X: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse.
To relieve burning after inter'course, apply ice or a frozen gel pack wrapped in a small towel to the vulva.
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