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One of the most common problems we face as gynaecologists on a daily basis is the very personal and often embarrassing issue of painful intercourse. By the time a woman comes to see us things are pretty bad. Often they are faced with resultant relationship issues and are quite desperate to get this problem sorted. Yes, in most cases it can be sorted and nobody should have to suffer from this.

The medical term for painful intercourse is Dyspareunia. It can be divided into two;

  1. Superficial which is mainly outer and inner vagina but not to the deepest part
  2. Deep dyspareunia which is pain deep in the pelvis and lower abdomen.

Let’s talk about each one in a bit more detail.

Superficial Dyspareunia
This is an extremely common complaint. The most common cause is thrush or other vaginal infections. Anything that impedes penetration such as scar tissue (from birth tears), an entry that is too narrow, painful hymenal tags, imperforate hymen, vaginal prolapse, or cysts or growths in the vagina can cause pain.

In older women and sometimes in younger ones vaginal dryness can cause pain and discomfort.

The treatment will obviously depend on the cause. Almost always these can be remedied with either medication or relatively simple surgery.

The most important thing is not to leave it. Get it sorted as soon as possible.

Deep Dyspareunia
The pain is deep in the pelvis or lower abdomen. The commonest reason is a retroverted uterus. This is when the uterus is facing downwards and is being “ hit “ directly. About 20% of uteruses face downwards and this normal. A change in positions is all that is needed to overcome this problem.

Other more serious problems such as endometriosis, adenomyosis (endometriosis of the uterus), ovarian cysts or pelvic infection (both acute and chronic) can all cause painful intercourse.

The most important message is don’t leave it. If sex has always been painful from the beginning you should address it. Relationships can be adversely affected and there is almost always a solution. If sex has been fine and then becomes painful especially deep, then attention is more urgently needed.

Seek help. The issue is extremely personal and private, so choose somebody who you can talk and relate to. That person could be your G.P. or specialist. Be honest and frank however embarrassing you may find it. THERE IS ALMOST ALWAYS A REMEDIAL ANSWER.

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