Painful Sexual Intercourse In Women & Men

In Women

Painful sexual intercourse is also known as dyspareunia. Women with dyspareunia may have a wide ranging array of symptoms from dull vaginal aching to a burning pain or itching discomfort.

So what do ladies feel?

Some ladies experience pain outright during entry while others complain of a deeper pelvic pain on deep penetration. The pain may occur before, during or after intercourse.

For some women, their dyspareunia may be situational, and they encounter it only with certain partners, or positional – with only some sexual positions. For others, the pain is present every sexual intercourse.

Dyspareunia can be present lifelong but in a significant proportion of women, it may only surface later in life, such as after pregnancy.

So why do some ladies feel dyspareunia?

The reasons for pain during intercourse can range from simple and easily addressed reasons to more serious underlying medical conditions.

Vagina dryness

Vaginal dryness is one of the more common causes of pain during intercourse. Usually ladies feel more superficial pain during sexual entry.

This may occur due to inadequate sexual arousal from inadequate foreplay, lack of anticipation or due to low levels of estrogen after menopause resulting in a condition called atrophic vaginitis.

Vaginal Infection

Vaginal infections may give rise to pain during intercourse as the vaginal canal and the cervix (entrance to the womb) may be inflamed. Very often, ladies will experience vaginal discharge as well.

Structural changes

Sometimes, structural abnormalities affecting the womb may give rise to a deeper pain. This may occur in conditions where there is abnormal scar tissue in the pelvis from previous infections or endometriosis. Uterine fibroids or the positioning of the uterus may also cause pain during intercourse.

Urine Tract Infection

As the urine tract is very close to the vagina, urine tract infections affecting the bladder may manifest as pain during intercourse but would be accompanied by other symptoms such as pain passing urine or foul-smelling urine.

Vaginismus

Vaginismus is a specific condition in which pain on attempted penetration occurs due to involuntary pelvic muscle spasms.

What can my doctor do for me

At DTAP Express, we offer urine rapid testing for chlamydia, gonorrhea and self vaginal swab tests for infections such as vaginitis.

If required and if your test results at DTAP Express is positive, a doctor’s review will be arranged.

During your visit, your doctor will take a proper history of your symptoms starting right from the start and the different situations which you may have felt the pain. Imaging such as ultrasound scans of the pelvis and high vaginal or endocervical swab tests for infections may be needed

What can we do for dyspareunia?

Treatments depend on the underlying cause contributing to pain during intercourse.

This may range from simple measures such as adequate lubrication during intercourse, to treatment of any vaginal infections. Treatment of pain due to structural changes may require a more extensive discussion with a gynaecologist. Certain specific conditions such as vaginismus are best addressed with specific treatment protocols.

Steps which may help reduce discomfort during intercourse include

1. Adequate lubrication, be it through
2. Extending foreplay to ensure adequate sexual arousal
3. Ffind alternative sexual positions that are pleasurable for both parties.

Remember pain should never be a part of pleasure!

In Men

Painful intercourse for guys

Painful intercourse or painful ejaculation is the most simple term to describe it. There are many other terms in the dictionary like dysejaculation, odynorgasmia, post orgasmic pain, dysorgasmia or orgasmalgia, etc etc but really there is no other simpler term to describe it but painful ejaculation.

To be honest, it is quite common but poorly understood phenomenon associated with sexual dysfunction.

It actually happens in 1–10% in the general population depending where you live and it actually increases to 30–75% among men who suffer from chronic prostatitis or chronic pelvic pain syndrome.

The severity of painful ejaculations may vary from a minor discomfort to excruciating pain.

The pain typically starts immediately before or during ejaculation and commonly lasts between 2 to 24 hours. It can be so painful that you can get turn off and your partner dissatisfied and concerned at same time.

So why do we have this happening?

1. Infections and sexually transmitted infections.

One other thing that all men shares besides our obvious anatomy, is our prostate.

The prostate is like the major town where our semen have to flow through and contributing to the flow. Imagine if there is congestion at the town caused by inflammation and foreign bacteria attacking. The very thought itself is painful. Chlamydia is often one STD/STI that results in prostatitis.

2. Stones

Stones that get stuck in the seminal vesicles which are like the canals in our town of prostrate. They can cause excruciating pain and inflammation.

3. Nerve causes

Sexual neurasthenia, big word here but it just means sensitive nerves firing off ad naseam till they are painful and exhausted.

4. Drugs

Essentially there is a small risk with all anti depressants: tricyclic antidepressants (TCAs, e.g. clomipramine, imipramine, desipramine, protriptyline, amoxapine), the selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine), venlafaxine and the MAOIs

5. Prostate issues.

The prostate itself can have issues with its own inhabitant cells with inflammation of prostate , prostate cancer, benign prostatic hyperplasia .

6. Post operation

Any prostate surgery , pelvic radiation and hernia repair amongst others.

7. Psychiatric

Psychological issues may also be the cause of painful ejaculations, especially if the patient does not experience this problem during masturbation.
Idiopathic – sometimes things just happen with no particular triger

What can doctors do for us?

Rigorous medical and sexual history! This along with chronological order of events is very important to finding out why. The type and location of the pain matters too. It is just not enough to tell the doc pain pain.

He/she will then do a focused physical examination that may disclose scars from previous surgeries or radiotherapy in the groin area whereas skin lumps and penile discharge may be suggestive of sexually transmitted diseases.

Palpation of a swollen and painful prostate during digital rectal examination is a diagnostic finding for acute prostatitis whereas a nodule can be felt in the presence of a prostate cancer.

Similarly, a urine test may confirm the location of urinary infection and screen for Chlamydia and gonorrhea. It is to confirm the diagnosis of prostatitis. And blood test for prostate specific antigen levels may also suggest prostate issues if raised.

Abdominal CT scans are rarely required. MRI studies may be helpful when investigating the cause of pudendal neuropathy. However, no obvious aetiology is found in a significant number of patients with the complaint of painful ejaculations, despite extensive investigation. Which lies in our Idiopathic category above.

Treatment of painful ejaculation must be tailored according to the underlying cause, if detected.

Painful ejaculation should never ever be taken for the peak of joyous fun with your partner.

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