Dyspareunia (painful intercourse)

Causes of dyspareunia

Lack of sexual arousal is by far the most common cause of painful intercourse. When a women's body is ready for sex, the vagina expands both lengthways and widthways. While this is happening, it becomes moist and lubricated to avoid any friction. The vagina wasn't designed to be penetrated in its unaroused state.

If you're sure you're fully aroused but still experiencing pain, check with your GP that you aren't suffering from an underlying condition. These can include:

• Childbirth - it's quite common for women to suffer some discomfort after childbirth, particularly if there was an episiotomy (a cut to make delivery easier).
• Menopause - intercourse may be more painful during the menopause as lower oestrogen levels cause a thinning of the vaginal wall. Ask your GP or local menopause clinic about oestrogen cream, which usually resolves the problem quite quickly.
• Urinary infections - cystitis or vaginal irritations such as thrush, vaginitis and genital warts are also likely to cause soreness. Once the underlying condition has been diagnosed, a course of treatment should solve the problem.
• Sensitivity to condoms - you may be irritated by certain makes of condoms, contraceptive creams or lubricants. Experiment with different brands.

The problem with pain is that it blocks sexual arousal, which causes further pain. Many women find that they're caught up in a pain cycle - having experienced painful intercourse before, they fear more pain which blocks arousal, causing more pain and so the cycle continues.

If the pain is in your lower abdomen or to one side, you should see your GP to rule out any gynaecological disorder such as:

• Endometriosis
• Prolapse
• Ovarian cysts
• Fibroids
• Pelvic inflammatory disease

Another possible cause is uterine retroversion, a natural condition where the womb tilts towards the back of the pelvis. In all these conditions, you may find that a different position, where thrusting is not so deep, is more comfortable.

If you experience ongoing vulval discomfort then you should check with your GP to see whether you're experiencing vulvodynia or vulval vestibulitus. You can get more information on these conditions from the Vulval Pain Society.

Treatments for dyspareunia

There are a number of self-help techniques wich may help:

• Relax. This is the most important thing you can do. Have a bath, use deep-breathing techniques or buy a relaxation tape from your local health shop.
• Work on relationship issues. You need to be sure that your head and heart are in the mood for sex as well as your body. If you're unhappy about something with your partner then sort it out first.
• Exercise your pelvic floor. This will increase the blood flow to your genital area and make you more conscious of any sensations of physical arousal.
• Use lubrication to speed up the process; keep a tube by the bed.
• Stimulate your sympathetic nervous system with exercise, or anything that will speed up your heart rate. Research suggests that your body will be more sexually responsive 15 to 30 minutes later.

Don't worry if none of the self-help techniques work for you, it's likely that whatever is causing the pain is treatable once appropriate help has been found.

If you've been suffering from painful intercourse for a while, it's essential to check that you're not suffering from an underlying condition.