Pain during sex or Dyspareunia
Pain during sex also known as dyspareunia, is surprisingly quite common in women and a lot of women would have experience pain during sex at some point during their lives. Dyspareunia is often more common in the young and inexperienced and also in peri-or menopausal women.
This topic is usually not discussed or talked about with your friends, doctor or even sexual partner as it is still a taboo. Besides not being able to enjoy sex, it will also be distressing if you experience pain during sex which may make the situation worse as it will make you tighten up and hence make the pain worse. It is important to recognise that dyspareunia often has an emotional affect not only on yourself but also with your partner and this may occasionally lead to a negative effect on a relationship.
In general most causes of dyspareunia are not serious. However there is a few that can be detrimental to your health and well being. Hence if you are experiencing persistent dyspareunia, it is crucial to get the problem sorted out as soon as possible not only for the benefit of your relationship but also from a medical point of view.
Usually dyspareunia can be divided into deep or superficial pain.
Lack of vaginal lubrication
This is the most frequent cause of pain during sex, which can be due to nervousness, failure to relax, not enough foreplay, or unskilled foreplay by your partner. Usually the pain can be resolved if you become more relaxed, increases foreplay or you use lubricants.
In peri or menopausal women, vaginal dryness is common due to a fall in the female hormone oestrogen. Using lubricant during sex will be helpful. Other treatment options includes hormone replacement therapy (HRTs) or vaginal hormone creams.
Vaginitis
Vaginitis which is inflammation of the vagina can be caused by infections such as thrush (candida), trichomonas or bacteria vaginosis (BV). Usually symptoms would include abnormal vaginal discharge, itching and burning of the vagina and vulva. Also, superficial infections such as genital herpes can also cause pain.
Other causes of vaginal infection such as foreign body in the vagina, such as forgotten tampon can cause pain especially if it is associated with an infection. Generally, curing the infection gets rid of the dyspareunia.
Vulvitis
Vulvitis due to inflammation of the vulva (opening of the vagina) may results in cracks in the skin of the vulva. A common skin disorder – contact dermatitis can affect the vulva where the vulva becomes inflamed as a result of a reaction to an irritant such as perfumed soaps, douches or lubricants. Vulvitis can cause itching, burning and pain including contact pain during sex.
Vulvodynia
This is a distressing condition in which the vulva is very sensitive and just touching can make the area very painful. The cause is unknown but there are many treatments available and is usually successfully treated.
Genital warts
Genital warts can sometimes cause pain especially if they become infected.
Injury
Commonly, women can get injury around the vulva or vagina caused by an episiotomy cut or tears during labour which may cause pain during sex that can last for several months. Badly healed stitches can also cause pain. If you experience any of these problems, you see should see a doctor sooner.
Vaginismus
Vaginismus can cause both deep and superficial pain and is due to spasm of the vaginal muscles, mainly caused by fear of being hurt. Vaginismus can make sex painful or impossible. Women with vaginismus may have never been able to use tampons or even have a pap smear test due to the fear of vaginal examinations.
Although vaginismus is often no one’s fault, it causes a lot of strong emotions in women who have vaginismus and they are usually angry with themselves, their partners or doctors.
Common causes of vaginismus include a restrictive upbringing, a history of rape or childhood sexual abuse and a history of painful vaginal infections such as genital herpes. Vaginismus can cause both deep and superficial pain during sex.
Problems with the cervix
During sex the man’s penis is able to hit the cervix. Hence infections of the cervix, such as that cause by STDs such as gonorrhoea, Chlamydia, trichomoniasis, genital herpes, etc and tender areas on the cervix can cause pain during deep penetration. This is also known as ‘collision dyspareunia’.
Also, occasionally an intrauterine contraceptive device (IUCD) or ‘coil’ sitting at the cervical canal can also cause pain during sex especially if it has been displaced.
Problems in the uterus (womb) or ovary
Various womb disorders such as fibroids, fixed retroverted uterus, can cause deep pain during sex. Ovarian cysts can also cause dyspareunia.
Endometriosis
Endometriosis is usually a painful disorder in which the type of tissues normally lining the uterus starts growing outside the uterus. The location of these tissues usually determines the amount of pain you may experience during sex. If the endometriosis is behind the vagina and lower part of the uterus, it is more likely to cause pain during sex.
Vaginal discharge
What is normal vaginal discharge?
Normal vaginal discharge is usually clear or milky white in colour and odourless. The amount and consistency of normal vaginal discharge can vary individually and also depending on where you are in your menstrual cycle.
Usually during Day 14-16 (mid cycle) of your menstrual cycle, you may notice profuse, egg white consistency discharge which is associated with ovulation. More often, this can be accompanied with a slight tinged of blood (mid cycle bleeding). The good news is that this is a sign of fertility and would increase your chances of pregnancy if you have sex during this period.
What is abnormal vaginal discharge?
Abnormal vaginal discharge is when there is a change in your ‘normal’ vaginal discharge, ranging from a change in colour, consistency or smell.
What is STIs related abnormal vaginal discharge?
This would usually signal the presence of an infection which could include:
Gonorrheal infections are manifested by cloudy yellow discharge often accompanied by pelvic pain and frequent urination.
Trichomoniasis (a parasitic infection) gives yellowish frothy discharge with bad odor. This is usually transmitted through unprotected sex. These infections are commonly treated with over-the-counter antibiotics, most effective one being metronidazole in forms of tablets, vaginal gel/creams and suppositories.
White, cottage-cheese-like discharge often accompanied by itching is due to yeast infection known as candidiasis.
Other type of infections that you could get which could cause abnormal vaginal discharge includes chlamydia, ureaplasma and mycoplasma.
Remember, infections like trichomoniasis, Chlamydia and gonorrhoea are considered sexually transmitted infections, while infections such as candidiasis and bacterial vaginosis are not considered sexually transmitted.
If you have noticed a change in your vaginal discharge or worried that it isn’t normal, see your doctor for further advice. If needed, swab tests can be performed to confirm the presence of any infection. Last but certainly not least, the majority of these infections are easily treatable.
For lady patients who prefer female doctors, we have 2 professional certified female Doctors to attend to your medical needs.
Trichomoniasis
Ladies, ever wondered what that yellowish-green vaginal discharge is? Besides Chlamydia or gonorrhoea, could it be due to trichomoniasis?
What is trichomoniasis?
It is a sexually transmitted infection (STI) caused by the parasite, Trichomonas vaginalis. Despite being not as famous as Chlamydia or gonorrhoea, it is one of the commonest STIs worldwide and is increasing in prevalence. Symptomatic trichomoniasis is more common in women.
So why the big fuss with trichomoniasis?
Research has shown that infection with T.vaginalis increases the risk of HIV transmission in both men and women. Trichomoniasis also increases susceptibility to other STI and is strongly associated with co-infection with other STI.
In women, trichomoniasis is linked with adverse pregnancy outcomes, infertility, pelvic inflammatory disease (PID), postoperative infections and cervical tumour.
In women, symptoms can range from none to severe pelvic inflammatory disease (PID).
Patient and sexual partner should be treated and should abstain from sex until treatment is completed and their symptoms have resolved.