When sex hurts: Causes of post-coital pain

When you think of sex, it is often accompanied by feelings of warmth and pleasure. But sex isn’t always a pleasurable, fun and pain-free encounter. At least not for those who suffer from intercourse pain – medically known as dyspareunia. It can be a huge thorn in a couple’s sex life.

More common in women than men, it is characterised by persistent or recurrent pain in the genitals during or after intercourse. The pain can range from mild to severe, and can be caused by both physical and psychological factors. When you experience a distinct and localised aching, burning, throbbing or ripping sensation, something is definitely wrong. Painful sex should not be ignored; apart from the pain, there is the likelihood of negative emotional effects that will result from it.

Intercourse pain in women

25 per cent of women are estimated to have experienced dyspareunia at one point or another in their lives. Women may experience dyspareunia either in the vagina or deep in the pelvis. Vaginal pain may be caused by:

1. Vaginal dryness

Insufficient sexual arousal and subsequent little vaginal lubrication can cause discomfort during intercourse. Certain medications, such as antihistamines, antidepressants, certain birth control pills and high blood pressure medications, can reduce lubrication. Vaginal dryness can also be caused by decreasing oestrogen hormone before and after menopause.

It can be resolved by:

· Ensuring that she is comfortable with intimacy

· Using a lubricant

· Longer foreplay

2. Vaginal infections 

Vaginal yeast infections can cause inflammation around the vaginal opening. The inflammation, otherwise known as vulvar vestibulitis, has been shown to cause pain during intercourse. The good news is that once treated, the pain goes away.

3. Vaginismus

This is a distressing condition that causes the involuntary spasm or tightening of the muscles around the vagina. Women suffering from vaginismus dread penetrative sex. While it doesn’t interfere with arousal, it can prevent penetration. The condition can occur due to the fear of being hurt or prior unpleasant sexual encounters, such as rape. The vaginal muscles tighten as a protective mechanism.

It can be resolved through psychological counselling and sex therapy.

4. Injury/trauma

This can be from female genital mutilation (FGM) or even a tear during childbirth to enlarge the birth canal (episiotomy). The injury makes intercourse painful, especially if it happens before complete healing.

5. Conditions like endometriosis, where the uterine wall grows beyond the uterus. 

Pelvic pain can be a result of:

6. Surgeries and medications

Pelvic surgeries, such as removal of the uterus, may cause scarring that can in turn lead to pain during sex. In addition, chemotherapy and radiation to cure pelvic cancers may cause undesirable changes that eventually make sex unbearable.

7. Psychological causes 

Since any form of sexual activity is deeply intertwined with emotions, psychological issues can indirectly lead to inadequate arousal that leads to pain and discomfort during intercourse. Depression, a history of sexual abuse, stress, low self-esteem and other psychological issues can cause the tightening of vaginal muscles.

Intercourse pain in men

Even through intercourse pain mostly affects women, it can also be experienced by men. Any pain during sex is not normal and should be investigated. Some possible reasons for this in men include the following.

1. Peyronie’s disease

This condition manifests as an abnormal curvature of the penis and is often caused by injuries to the penis during sexual intercourse. The curvature can be so severe that it prevents comfortable intercourse. The condition can be rectified surgically or medically to straighten the bend.

2. Foreskin issues

The inability of the foreskin to retract during intercourse in uncircumcised males may result in an overtly tight feeling that eventually becomes painful. This condition is also called phimosis. Apart from tightening of the foreskin, friction and inflammation of the same may also result in pain. If the pain doesn’t abate on its own, it can be resolved using a prescribed steroid to stretch out the skin, or by circumcision.

3. Prolonged erection/priapism

Sometimes some erectile dysfunction drugs or antidepressants will cause some not-so-pleasant side effects, like a non-sexual on and off, or a persistent erection that lasts longer than four hours. The penis gets exceedingly tender and painful. If left untreated, this condition can cause erectile dysfunction and thus should be treated as an emergency to prevent permanent damage to the penis.

4. Sexually transmitted infections

Gonorrhoea and herpes are common culprits. An infection can lead to burning and itching sensations and cause blisters or sores on the penis, leading to painful sex. Usually upon treatment, the pain goes away.

5. Urinary tract infections

While they are more common in women – because their urethra is shorter and closer to the anal opening – urinary tract infections affect men as well. Men make up around 30 per cent of the urinary tract infections presenting in our local hospitals. Usually, the burning sensation felt when urinating can also lead to pain during ejaculation and also a foul-smelling discharge. This should go away as soon as the infection clears.

Nancy Nzalambi is a public health research scientist with NHIF?