Why sex can be painful

I t’s not unusual for a woman to experience discomfort with intercourse at some time- but often it’s a temporary problem which clears up. Some women have more serious difficulties-perhaps they have enjoyed a good sex life for years but find they develop a problem after childbirth or during the ‘change life’, while others find intercourse painful right from the start. Both the woman and her partner may try hard to improve the situation but she continues to experience pain. This can be so severe that the couple find they cannot achieve full penetration, and sometimes none at all.

Women with this type of experience often turn up fairly early in the course of their relationship, but others wait until quite a long time has elapsed – perhaps when their relationship seems on the point of breaking up, or they have finally been forced to realize that it won’t just ‘go away if they wait long enough.

Or it may be a doctor who first brings up the subject; if a woman turns up for an examination – say, related to a cervical smear or fitting a contraceptive- the doctor may find she has such a tense, tight or dry vagina that he can’t examine her at all, so naturally he will want to ask whether she is having problems with intercourse as well.

Some women who find attempts at intercourse difficult and painful tell their doctor that they think they are ‘too small’. Occasionally this can be due to a tough hymen which has a rather small opening(thc hymen is the ‘maiden head’, a membrane which partially closes the lower end of the vagina in a virgin).

There is usually a perfectly normal vagina behind the hymen, and the doctor can show the woman how to use a simple lubricating jelly to gradually stretch the opening themselves, grad-ually inserting one, two or even three fingers. More rarely, if the hymen is very thick and has a tiny opening it has to be stretched and incised by the gynaecologist, under a general anaesthetic; it heals quickly.

The ‘smallness’ some women complain of is nearly always due to tension, apprehension and some underlying fear of penetration. Many have the idea that the hymen is not at the entrance to the vagina but is a membrane stretching across some way inside; they are terrified that the thrusting of the penis would mean a ‘breaking’ through the membrane- and dread that this will be a painful and bloody experience.

In fact, nowadays, with the kind of active life young girls lead, and with tampons so widely used for sanitary protection, it is much more usual to find that there is no hymen at all. Any pain or tightness a woman experiences is more likely to be caused by a spasm of the muscles at the entrance of the vagina. This spasm happens when a man tries to penetrate her during intercourse, or when the doctor tries to examine her. The vagina itself when relaxed is not ‘small’; in fact it is extremely rare to find a vagina so small that it affects or prevents enjoyable sex.

Intercourse may sometimes be painful if the man penetrates the woman very quickly, without any preliminary caressing or lovemaking; she may be still quite unaroused, perhaps tense and certainly dry, because the natural ‘lubrication’ is only secreted in the vagina when the woman feels sexually excited. If the man also has a very quick climax, this increases the difficulty, because she doesn’t even have time to experience arousal from the movement of the penis once the man has entered her.

This kind of difficulty is often something that a man experiences at the start of a new relationship when he is nervous and overanxious – and in this case it’s likely soon to get much better. But, if it is a more serious potency problem, in which the man can only achieve intercourse by rapid penetration and climax, then the woman’s frustration may lead to her becoming’frigid’; intercourse then continues to be painful because she is dry and tense.

Rough and violent intercourse is another cause of pain, although some women do find this kind of lovemaking very exciting and enjovable. More often, it’s a question of an inexperienced or nervous man being rather clumsy and, if the cervix (neck of the womb) means that deep woman herself is more confident, she can do a penetration exerts a lot of pressure on sensitive lot to teach him a more relaxed and skilful areas. In this instance, the doctor may be able to approach. Give advice on different positions for lovemaking There is another kind of pain which can occur which will avoid the sensitive areas – or the when a man penetrates a woman very deeply; in couple themselves could try experimenting with some women the position of the womb and the different positions.

The tensing of the whole vagina, and a spasm of the muscles around the entrance, may well be due to some kind of fear of sex. This condition is called When any kind of penetration is attempted, the woman may also arch her back and draw her knees together, so that it’s quite impossible even to make any kind of near approach.

With some women, the doctor can in time encourage her to explore her own vagina, so that gradually she finds out it is roomy and long enough to take three fingers fully without any pain. Once she’s able to accept the reality of this, she is usually able to relax enough to enjoy intercourse without finding it painful.

But there are some women who find all this quite impossible; despite a very patient and skilled approach by the doctor, he cannot succeed in getting her to insert even the tip of her own finger, let alone allow him to give her a vaginal examination.

She could be said to have a’fear of sex’, but this is just one aspect of a set of complex, often deeply unconscious, emotional conflicts. She may reel any attempt at penetration’inside’ is a threatening, perhaps dangerous, and’forbidden’ activity. Her problems are nothing to do with the physical nature of her vagina, so it’s a question of her acknowledging this fact and seeking help from a skilled psychotherapist.

Some young women who have always found sex easy and enjoyable find, after childbirth, that intercourse has become uncomfortable and even painful. It’s generally quite well known that these difficulties – as well as the post natal ‘blues’ – do often occur, as a passing phase.

But this doesn’t always reassure a new mother; sometimes she has a deep underlying fear that the baby’s birth has really damaged her physically, especially if she has had a rather long labour and stitching afterwards. She may be afraid she has been stitched too tightly or think the tear might ‘burst’ if there is full penetration. Like someone guarding a ‘woundecr place she is likely to tense up and dry up with apprehension when she and her partner try to have intercourse.

A woman’s womb and vagina are all ‘inside’ her and she cannot have a good look and reassure herself that all is normal. Tiredness and anxiety over earing for the new baby is likely to make her rather pre-occupied and unlikely to feel very ‘sexy’.

The doctor may be helpful in two ways. Providing a post-natal check up six weeks after the birth and getting the woman to explore her own vagina, can help to reassure her that she has not been ‘damaged’; showing her how to relax and use a good lubricating jelly to overcome her present dryness can ease the whole situation. He can also give her the opportunity to talk about her feelings and any anxieties she may have about caring for the baby and relating to her husband. After all, this can be a time of maximum uncertainty about herself, not only as a woman, but as a mother and a wife.

Temporary discomfort, itching and perhaps some pain in intercourse can be caused by the dryness which accompanies vaginal infections-in particular the fungal yeast infection known as thrush. Pregnant women often develop this owing to the change in their vaginal acidity brought about by the pregnancy. It may also develop following antibiotic treatment for some other illness. This condition is quite easily treated by the doctor.

In the menopausal years, many women who have never had any sexual difficulties before, may develop discomfort and increasing pain from intercourse. This is due to a lessening output of oestrogen, the hormone which in her fertile years has nourished the vagina, keeping it comfortably moist and supple.

This can generally be easily helped with applications of an oestrogenic cream onto the vaginal walls, to restore them to their previous condition. The use ofa good lubricating jelly in the vagina during intercourse is also very helpful. It is important that older women should under-stand that painful intercourse at this age does not indicate that she is ‘too old’ for intercourse and should give it up. O n the contrary, it is important for both partners that they should cherish their sexual life together, so that they can continue to have” satisfactory intercourse throughout the years ahead.

Is intercourse ever painful for men?

Whatever the reason, if a woman is suffering from a dry, tight vagina then her male partner is obviously affected too. Penetration and movement are bound to be painful for him if the vagina is not open and well-lubricated. But there are other possible causes of discomfort (for example, an infection or inflammation of the penis) and a few men have a foreskin which is too tight; this can be put right with a simple operation. If there is no obvious physical cause, then the problem is likely to be an emotional one -perhaps excessive fear about the ‘vulnerability of the penis. A skilled psychotherapist may be able to help overcome this, and your doctor should be able to recommend you to one.