For one in 10 women, sexual intercourse can be painful.
The pain can stem from a variety of reasons, each one impacting the woman herself as well as her new or existing romantic relationships, Nelly Faghani, a registered physiotherapist at Pelvic Health Solution, says.
“It’s a quality of life issue,” she said. “Intimacy is important for so many relationships. There is no normal number of times that people have sex, but whatever that normal is for you and if it’s important for you and your partner, then it’s going to impact our quality of life significantly.”
It’s a common issue that many women of all ages face and not just those who are post-menopausal.
But there are ways to address painful intercourse (also known as dyspareunia), or at least manage it, Faghani says. And it’s important that women do not dismiss the pain, but instead address it.
“As a physiotherapist that treats pelvic dysfunction, so many of my patients have pain with intercourse,” Faghani says. “It’s something that I see and treat successfully all the time. There’s just so much you can do about it.”
Unless addressed by a physician, physiotherapist or similar expert, many women may not know the cause of their sexual dysfunction — and the cause may not always be physiological, but emotional as well, the Mayo Clinic says.
Below are some of the most common causes of sexual pain in women according to Faghani. See if any of them sound familiar.
“If we anticipate pain, or we’re scared, our pelvic floor muscles are the first group of muscles that tense up,” Faghani explains.
This can also happen if you’re stressed at the moment or in life, the Mayo Clinic adds.
Anxiety, depression, concerns about one’s physical appearance, fear of intimacy or relationship problems can also contribute to the discomfort, the Mayo Clinic adds.
“Dryness could be because of lack of foreplay or it could be because of hormonal reasons like with menopause where you get some genital urinary symptoms including dryness,” Faghani says.
According to eMedicineHealth, vaginal dryness caused by insufficient stimulation is the most common reason in this case. It can inhibit arousal and make intercourse uncomfortable.
In terms of hormonal issues, these cases often involved a drop in estrogen levels after menopause, after childbirth or during breastfeeding, the Mayo Clinic says.
3. Pelvic floor muscle over-activity
“This means the muscles are short and tight,” Faghani says. “In order for any sort of penetration, the pelvic floor muscles have to relax – they need to lengthen and be at their full length to be able to accommodate anything going inside.”
So if the muscles are short and tight or overactive, that will contribute to the pain.
“There could be some scarring from an episiotomy, for example, or some tearing,” Faghani points out. “The scar may not be malleable or soft enough and that can cause a little bit of pain.”
According to BabyCentre Canada, an episiotomy is a surgical cut in the muscular area between the vagina and back passage. While it used to be a routine part of labour, it isn’t any longer, but your physician may suggest it if the baby is becoming distressed and needs to be born quickly.
The first time a woman has intercourse after the procedure may evoke feelings of tenderness and tightness, the website adds.
According to Faghani, trauma, injury or irritation is another common source of intercourse pain.
It could be from an accident or some type of pelvic surgery, for example, the Mayo Clinic says.
Painful intercourse is also common after childbirth, Medical News Today reports, and up to 45 per cent of women may experience postpartum dyspareunia.
How to manage
In terms of dryness, Faghani says women should not be putting soap in their vaginas when cleaning. If soap is used inside, it may contribute to the dryness and discomfort.
Women also need to be more aware of their pelvic floor muscles, Faghani adds.
“We need to make sure to let them go so we don’t tense up like you’re stopping the flow of urine, but exactly the opposite – so letting go – or lengthening the pelvic floor muscles,” she says.
As well, communication with one’s partner is important.
“We need to communicate with our partners so that there’s good foreplay and lubrication,” she says. “If it’s because of hormonal reasons that women are not lubricated enough, then they need to use the appropriate lubricant.”
Faghani points out that women also can’t be afraid to mention if there is any history of trauma to their genitals to their partner. Speak to someone who has experience with this and it will help you manage any feelings or discomfort in this department.
However, it is important to consult with your physician should there be an issue pertaining to painful intercourse.