Painful Intercourse Causes and Treatment

I'm a woman (60) who had not had sex for 10 years. I recently decided to start again, but intercourse was very painful. I have tried several times, but with the same results. What causes this pain and what can I do that will help?

First of all, you are not alone. Millions of women experience pain during intercourse, but most are too shy or embarrassed to bring it up. I congratulate you for raising the question! Intercourse is a wonderful way to connect with someone that you care for and can be enjoyable throughout your entire life. There can be different challenges every step of the way.

Let's begin by clarifying some definition.

Dyspareunia is persistent genital pain associated with intercourse. Vaginismus is persistent involuntary spasm of the muscles of the outer third of the vagina that interferes with vaginal penetration, making intercourse painful if not impossible.

It can be difficult to distinguish between these two conditions. Chances are, if you have been able to successfully have intercourse earlier in your life, you have dyspareunia and not vaginismus. This is relevant, because the causes and treatments of dyspareunia and vaginismus are a little different.

When I approach dyspareunia, I think of two different “buckets” of causes:

Pain with insertion or entry. Contributing factors include:

• Poor lubrication (dryness). After both childbirth and menopause, your body's estrogen production drops. This lack of estrogen can lead to marked vaginal dryness and irritation. Certain medications such as antidepressants, high blood pressure medications, sedatives, antihistamines and birth control pills can also cause vaginal dryness.
• Infection such as bacterial vaginosis or yeast.
• Vaginismus (involuntary muscle spasm)

Pain with deeper penetration. Contributing factors include:

• Conditions of the female genital tract such as uterine fibroids, ovarian cysts, and endometriosis.
• Prior surgery of the genital tract such as hysterectomy.
• Medical treatments such as chemotherapy or pelvic radiation.

Emotions can also play a big role here. If you are worried, scared or anxious, have low self esteem, a past history of sexual abuse, or even an unhappy relationship, then you may not be able to relax enough to let the physiologic mechanisms to kick in that would allow intercourse to be enjoyable.

Because this can be a complex problem, each specific issue with its own unique set of solutions, I highly recommend scheduling a visit with your doctor. Your visit will likely include a detailed history and pelvic exam. Even though it might feel embarrassing, be as forthcoming as you can — this will help your doctor understand the real cause of the problem.

Most importantly, don't worry! There are many solutions ranging from vaginal lubricants to low-dose intravaginal estrogen to couples counseling…there is even pelvic physical therapy! Partner with your doctor to find the treatment plan that is right for you.