Painful Sex

Painful Sex

Sex should not hurt. Some people like intense stimulation or pain with sex; for them pain is a pleasurable sensation. Most commonly pain is an unwanted sensation. Pain during intercourse usually interferes with pleasure and inhibits sexual arousal. Pain reduces likelihood of successful penetration and can lead to fear of penetration and sexual avoidance.

First intercourse

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.

Vulva Allergy

The vulva skin can breakdown due to allergy. If you have skin allergy on other past of your body you may be prone to allergy on your vulva. The following are common causes of vulva skin irritation and allergy:

  • Toilet paper

  • Lubricants

  • Any medication, either prescribed or over-the-counter

  • Perfumed products

  • Femine sprays
  • Old medication

  • Methylated spirits

  • Aloe vera

  • Tea-tree oil

  • Sanitary pads (tampons are better)

  • Nylon undies, g strings

  • Chlorinated pools (swimmers)

  • Antifungal creams and pessaries

  • Antiseptics

  • Nail polish

  • Latex condoms

painful sex

Vulvodynia

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

Anal Sex

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

Vaginismus or Pelvic Pain/ Penetration Problems

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)

Pain When Retracting Foreskin

Some men experience pain when their foreskin is pulled back over the head of the penis too quickly or too far down the shaft. Partners accustomed to circumcised men can be a little too enthusiastic when giving manual or oral sex, pulling back the foreskin to stimulate the head of the penis. This is uncomfortable and can be quite painful. Uncircumcised men are more sensitive around the head of their penis than circumcisded men and do not need their foreskin pulled back; the foreskin is there to protect the penis and it feels good moving naturally.

Sometimes uncircumcised men may be more sensitive than circumcised men when first having intercourse. Wearing a condom can reduce sensitivity till you get accustomed to the feeling (it is also a good idea to use a condom to avoid sexually transmitted infections). Also, touching the head of the penis during masturbation can help you desensitise the head of your penis. You can try making your hand into a fist and pretend that you are penetrating a vagina or an anus by pushing down through your curled fingers so that they make a tunnel shape. You can also buy sex toys such as fake orifices, that can assist with this.

Phimosis

The foreskin of young boys is often attached to the head of the penis and cannot be fully retracted. This is completely normal – the foreskin will detach in time. As a teenager it is more likely that the foreskin can be fully retracted, however between 1-5% of men will continue to have a non-retractable foreskin. The medical name for this is phimosis.

If the foreskin is only slightly tight, a minor phimosis, it may be possible to stretch the foreskin by pulling it back tightly against the head of the penis. Or the fingers can be inserted into the opening and used to stretch the foreskin and applying outward pressure. Your G.P. may recommend that you use a steroid cream in conjunction with a stretching device. See Norm UK Stretching guidelines for how to stretch a tight foreskin. Those with an extremely tight foreskin may require a simple surgical intervention.

For more information on phimosis treatment see Norm UK Clinical Guidelines for Phimosis

Painful Ejaculation

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