Painful Sex

There are many myths about first intercourse. A common myth is that a girl will feel discomfort with first intercourse and may bleed. This false belief encourages girls to tolerate pain until they get used to it, whilst suggesting to boys that they should persist with intercourse as the girl’s discomfort or pain will diminish over time.

Continuing with intercourse when it is painful and uncomfortable is nonsense. Painful penetration is a sign that the body is not physically ready, not aroused enough. It also may indicate that they are fearful and need more reassurance or loving to relax. In females it may also be related to uncommon condition of imperforate hymen.

If you are experiencing pain during intercourse, your body is trying to tell you something, so don’t override it by pushing your body to do something it is not ready to do.

Your body can tell you when it is prepared for penetration. To test if it is the right time to begin intercourse you can press the pad of your finger gently against the opening of your vagina. If ready, you will be wet and there will be no resistance. You may even feel a pulling or sucking inwards. If you are met with resistance, then delay penetration and do something else that you find arousing. Resistance may cause pain. Pain is not fun and sets up expectation of further pain, which results in more resistance with the next attempt. To test if you are ready for anal intercourse, try with a little finger, or tiny dildo. Make sure you are enjoying a finger before graduating to anything larger.

For partners, if you are sensitive to your lovers readiness for intercourse you are on your way to being a good lover.

Vulvodynia is a descriptive term which refers to pain in the vulvar area, but may also include the clitoris, perineum (space between the vagina and the anus) & anus. When asked to describe their pain women described; burning, itching, dryness, rawness and a drawing sensation. The symptoms may range from mild to severe. Some women may have occasional discomfort, while others experience chronic pain. Vulvodynia may prohibit women from wearing jeans or tight clothing and often causes pain during intercourse. Vulvodynia is not a psychological problem but can result in psychological effects such as embarrassment, shame, sexual and relationship avoidance and lower quality of life.

Women with Vulvodynia often report other conditions such as skin allergy, bowel problems, urological conditions, chronic pelvic pain, muscle, bone and joint pain conditions.

A clinical study of 744 Australian women, diagnosed with vulvodynia, examined the age distribution of patients and studied the age of symptom onset (Jantos 2007). The study found that 75% of the vulvodynia patients were under the age of 34 years. Prevalence peaked at 24 years of age.

An unexpected finding in the Australian study was that a significant number of the women reported the onset of symptoms in their early childhood or shortly after puberty, with commencement of tampon use, first medical exam, or with first attempts at sexual activity. These findings, for the first time, highlight the very early onset of symptoms for at least half of the vulvodynia patient group. These findings were initially met with a degree of scepticism but a later retrospective study of vulvodynia in preadolescent girls confirmed the occurrence of vulvodynia in children between ages four to eleven, with duration of pain varying from several months to seven years (Reed & Cantor, 2008).

A range of causes of vulvodynia has been proposed, immunological (lichen Sclerosis), hormonal (menopause, cancer induced menopause, irregular periods), inflammatory (eczema, dermatitis, psoriasis), infections (BV, STIs) and neuropathic (pudendal neuralgia) (Haefner et al., 2005). It is unlikely that there is one single cause for vulvodynia.

Reference sites and support

Vulvodynia support group

What is normal down there

Women’s Experience of Lichen Sclerosus

Anal sex should not hurt. If you want to be able to regularly participate in this activity then make sure it never hurts. Continuing on with painful sex in the hope it will get better is misguided. It is hard to start enjoying sex from a point of pain. It is better to be aroused and use lots of lube. Start little. Enjoy a little finger or dildo in your bum before you put bigger things in there. Avoid going from no anal penetration to penetration with a penis, as this is likely to be unsuccessful. Try starting with a finger and increase to 2-3 before you insert a penis. You might want to try using gloves as they feel nice with lube.

More information see butt sex for beginers at Babeland

Persistently painful sex can lead to Vaginismus. Anticipation of pain can cause the pelvic floor muscles to involuntarily contract to the point that it is difficult, painful or impossible to have vaginal penetration. Vaginismus can be a secondary condition of Vulvodynia (see above) undiagnosed endometriosis, or pudendal neuralgia. This is a very distressing situation for women and their partners.

Sometimes women do not know they have Vaginismus until they first try intercourse. Women who have avoided vaginal penetration, i.e. they have not used tampons or inserted their fingers, may be surprised that they can not have sexual intercourse. Vaginismus can be treated with pelvic floor physiotherapy or combination psychotherapy (Cognitive Behavioural SexTherapy) and pelvic floor physiotherapy.

Some women and their partners find the information on Vaginismus by the consumer website Vaginismus.com helpful.

For further information view my presentation on Genito Pelvic Pain Penetration disorder (GPPPD)

Painful ejaculation is an acquired condition where painful sensations are felt in the perineum or urethra and urethral meatus. There are multiple possible causes e.g. ejaculatory duct obstruction, postprostatitis, urethritis, autonomic nerve dysfunction. Initial investigations suggested by Andrology Australia are:

• Urine analysis (first pass urine- chlamydia & gonorrhoea urine PCR test; midstream urine MC&S)
• Cultures of semen (MC&S)
• Cystoscopy Treatment:
• Aetiological treatment (e.g. infections-prostatitis, urethritis): Implement disease specific treatment

if no physiological process are identified –

Behavioural techniques: Use of relaxation techniques by pelvic floor pshyiotherpaist and Psychosexual counselling