What is the cause of pain during intercourse?Expert explanation

If this sentence “Painful sex” Sounding the alarm, you may have experienced some surprising emotions accompanying this difficulty health Questions: Shame, embarrassment, self-blame, feeling self-conscious about nervousness or not “fun in bed”, to name a few. Whether you are just beginning to experience painful sex or have experienced sex for a lifetime, you should know-this is abnormal and there is a solution! I want to admit that if this is something you have been living in, then you are not alone. This is very common, and it is actually never too late to find out the cause of painful intercourse.

When sex is unpleasant, letting go requires courage and confidence, time, access to medical care, and good providers to diagnose you correctly. For some people, it may be a lot to face this, and it is a sensitive topic… so honestly, it is no wonder that many people choose to suffer quietly during painful sex or simply give up pleasure.Fortunately, times are changing. Although vaginal patients are not always easy to get a good diagnosis, they have general knowledge and knowledge about the treatment of vaginitis. Dyspareunia (Painful sex) has spread like wildfire in the women’s health community in the past five years.

If you are dealing with painful sex, check out these common causes and learn more about ways to find relief.


An extremely common cause of pain during intercourse usually stems from damage to the vagina, perineum, or pelvic floor muscle tissue after birth. Although most vaginas tend to heal completely and normally after birth, there may be complications after birth or complications that may cause painful intercourse during the healing process. The good news is that they are usually completely treatable! The reintegration of sex into life after the baby is born usually happens after the last postpartum appointment. Because of this, coupled with the general lack of screening and education about painful sexual behaviors, many people are surprised by this situation. This, combined with the lack of education/discussion from postpartum providers, means that many people who give birth don’t know what’s going on, confused or afraid that they “ruined their bodies” even though this pain is beyond their control.The following are some specific causes of postpartum sexual pain and recommended medical providers

Causes of painful intercourse after birth

  • Due to the side effects of breastfeeding, low estrogen levels cause vaginal dryness
  • According to the American Physical Therapy Association, the trigger point “is a small allergic point located in a tight skeletal muscle band,” which may be caused by improper healing after childbirth, and is usually the culprit for painful intercourse.
  • Scar tissue from lacerations or tears in the vagina, perineum, or rectum during childbirth
  • Tissue or skin that is not completely closed after receiving the suture
  • Tight tissue or skin sutured after tearing
  • Skin tag
  • Improperly stitched laceration/tear

Common treatment options include:

  • If the pain is caused by low estrogen levels caused by breastfeeding, topical vaginal estrogen may reduce the atrophy of vaginal tissues, or the pain should stop after stopping breastfeeding
  • Midwife or doctor topically apply silver nitrate to close unhealed wounds/open tissues
  • Pelvic floor physical therapy to assess for trigger points, hypertonia, muscle weakness, or pain caused by bladder or rectal prolapse
  • Dry vaginal needles (to be done by a pelvic floor physiotherapist)
  • Vaginal and perineal massage softens/breaks down painful scar tissue
  • Remove skin tags
  • Surgery to repair improperly healed tears

Who to see:

  • Pelvic floor physiotherapy (usually covered by insurance!)
  • Women’s health nurse practitioner or certified midwife
  • Obstetrician and Gynecologist


Vaginismus is a painful condition that is classified as a genital pelvic penetration and pain disorder that affects 5% to 40% of women. Due to lack of reports, the incidence is unclear. It is often difficult for people with this disease to insert or insert anything into the vagina in any form, such as during sexual intercourse, using tampons, or may feel burning or tingling during intercourse. This disorder is considered emotional and physical, and physical symptoms usually lead to emotional symptoms, and vice versa, continuing to make the problem persist.

Causes of vaginismus Specific to the affected individual, it may be due to medical vaginal disease (congenital disease) at birth, inflammation, vaginal blood flow changes leading to vaginal tissue atrophy (shrinkage), loss of skin integrity, or neurological problems. Difficulties may also stem from deep-rooted belief systems and socialization, fear of sex, thinking that sex is wrong or bad, or feeling uncomfortable with sex. In the end, someone might view this condition as a side effect of PTSD from sexual assault or trauma. Everyone’s treatment is different because the root cause of the condition is so individual.

Common treatment options include:

  • Desensitization therapy
  • Use a vaginal dilator to help someone adjust to how it feels when inserted
  • Vaginal Botox Injection
  • Pelvic floor exercises and relaxation techniques (reverse kegals)
  • Myofascial release of pelvic muscles, abdomen and thigh muscles
  • Hypnotherapy
  • Talk therapy
  • Anti-anxiety drugs
  • Sensory focus exercises to help relax the vagina and increase libido

Who to see:

  • Pelvic floor physiotherapist (usually covered by insurance!)
  • Sex therapist
  • Pelvic pain specialist
  • Women’s health nurse practitioner or certified midwife
  • Obstetrician and Gynecologist

Vulvar pain

According to the National Vulvar Pain Association, “Vulvar pain, simply put, is chronic vulvar pain with no clear cause. The location, duration, and severity of the pain vary from patient to patient.” Burning sensation is the most common symptom. Your provider can diagnose where the pain occurs, how long it lasts, and whether it generalizes to the entire vulvar area, clitoris, or localized to the vulva The specific details of a certain area of ​​the vulva. Most women who experience this condition have localized vulvar pain, in other words, pain when stimulating or touching a certain point or place on the vulva, such as sexual intercourse, inserting a tampon , Gynecological examination, sedentary and/or wearing well-fitting pants. The reasons for this condition are not fully understood and more research is needed. However, it is clear that this condition should be diagnosed by pain other than infection.

According to the National Vulvar Pain Association, some Suspected causes of vulvar pain Listed below:

  • Nerve injury or irritation that transmits pain from the vulva to the spinal cord
  • Increased number and sensitivity of vulvar pain nerve fibers
  • Elevated levels of vulvar inflammatory substances
  • Abnormal response of different types of vulvar cells to environmental factors such as infection or trauma
  • Genetic susceptibility to chronic vestibular inflammation, chronic generalized pain, and/or inability to fight infection
  • Weakness, cramps, or instability of the pelvic floor muscles

Treatment options include:

  • Recognize and stop irritants
  • Oral “pain-killing” drugs
    • Tricyclic antidepressants
    • Serotonin-norepinephrine reuptake inhibitor
    • Anticonvulsants
    • Opioids
  • External hormone cream (estrogen and testosterone
  • Local anesthetics
  • Topical anticonvulsants or antidepressants
  • Pelvic floor physiotherapy
  • Nerve block
  • Nerve stimulation and spinal cord infusion pump
  • surgery

Who to see:

  • Gynecologist or urologist
  • Pelvic pain specialist
  • Pelvic floor physiotherapist
  • Women’s Health Practitioner or Certified Midwife
  • Neurologist
  • Dermatologist


According to the North American Menopause Society (NAMS), approximately 17% to 45% of women experience painful sex during their perimenopausal and postmenopausal lives. Changes in hormone levels will thin the vaginal tissues, reduce the natural lubrication of the vagina, reduce vaginal blood flow and elasticity, all of which can cause severe intercourse pain (painful intercourse). In addition, once someone experiences painful intercourse, the subsequent psychological effects may cause anxiety, fear, and stage fright, which inhibits the ability to engage in sexual relationships physically and mentally in the future. In addition to the physical obstacles to enjoying sex, the mental and emotional indifference caused by low libido and inability to be awakened is also caused by hormonal changes. These are common complaints of postmenopausal patients.

Treatment options include:

  • RX topical estrogen to treat vaginal atrophy
  • Vaginal moisturizers and lubricants (if the pain does not improve, please see a doctor)
  • Increase blood flow with stimulation and have regular sexual intercourse
  • Vaginal dilators for painful sex
  • Pelvic floor physiotherapy for painful intercourse
  • Sex therapy/counseling to solve the problem of low libido
  • Yoga improves arousal and libido

Who to see:

  • Obstetrician and Gynecologist
  • gynecologist
  • Women’s Health Practitioner or Certified Midwife

Infections: yeast, urethral or sexually transmitted infections

Infections of the vulva, vagina, urethra, cervix, or uterus can cause inflammation, irritation, itching, bright red or raw mucosal tissue in the genitals, open ulcers or itchy bumps, and are likely to cause pain during intercourse. Contrary to chronic pain conditions or hormonal imbalances, signs of infection may be foul-smelling vaginal discharge, increased discharge, unexplained bleeding after intercourse, painful deep penetration of the vagina, painful urination, thick white discharge, painful or itchy vulva Ulcers or lesions, or vaginal swelling. If you are concerned that you may be infected with a virus or have unprotected sex, please consider seeing a doctor for an appropriate diagnosis or STI test.

Infections that may cause pain during intercourse:

  • gonorrhea
  • Herpes
  • Molluscum contagiosum (if the sore is infected)
    Pelvic inflammatory disease (a disease caused by untreated sexually transmitted diseases)
  • Chlamydia
  • Trichomoniasis
  • Urinary Tract Infection
  • Infection after miscarriage
  • Infection after IUD placement

Who to see: *The family planning provider is an expert in this type of diagnosis

  • Obstetrician and Gynecologist
  • gynecologist
  • Women’s health nurse practitioner or certified midwife

To summarize, I hope this article will help some of you find answers to painful conditions that can be cured! The conclusion is that if you feel pain during sex, don’t think it is normal, it is something you must endure or cannot cure. If you see an answer given to you by a provider that makes you feel unsatisfied or eases your pain, please find someone else. You can tell your provider that you have completed the research and you think you have ____, please fill in the blanks. If your obstetrician or obstetrician or doctor does not seem to understand the situation or provide you with resources, consider finding a pelvic pain specialist or requesting a referral to pelvic floor physical therapy to continue to find answers. Don’t be afraid to ask for referrals to experts as needed. Good luck to friends and pass this article-spread the word! Sex should not be painful, you can find the answer.

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