Female sexual problems tend to fall into four broad categories. These are:
· Lack of desire or libido
· Difficulty with arousal
· Difficulty or inability to achieve orgasm
· Pain caused by sexual intercourse
The four are sometimes intertwined creating a multi-faceted sexual health problem,
even though they may all have a common source. Here, we are addressing the problem
of painful sexual intercourse which can be so bad as to affect the woman’s fertility.
Dyspareunia (Painful intercourse):
Dyspareunia is the medical term to describe painful sexual intercourse. It is estimated
that at least 1 in 10 sexually active women suffer a significant degree of painful
intercourse (dyspareunia). The classification of dyspareunia is either based on
timing of onset or the location of pain.
Primary dyspareunia describes painful intercourse which starts from the first time
the woman becomes sexually active and persists thereafter.
Secondary dyspareunia is when the woman has had normal painless sexual intercourse
before and then starts experiencing pain later on in her active sex life. This could
be years after her sexual debut.
As mentioned earlier, painful sexual intercourse can also be classified according
to location of the pain. In this regard there is:
Superficial dyspareunia: As the name suggests, this is pain experienced superficially
in the vaginal canal, typically at the point of penetration or just inside the vaginal
Deep dyspareunia: This describes pain that is only experienced when the penis is
thrust deep in the vagina.
Some women will experience both superficial and deep dyspareunia.
Causes of painful sexual intercourse:
Let’s start with primary dyspareunia (painful sexual intercourse):
Many young women will find that from the moment they start being sexually active,
any attempt at penetrative sex causes pain. Initially this may be dismissed as due
to lack of experience but when it persists, there is a build up of frustration and
anxiety. This, of-course feeds into the problem and will tend to make it worse. So,
what could are the causes?
Vaginismus: This is the intense involuntary spasms of muscles surrounding the lower
third of the vaginal canal. Any attempt at penetration will trigger pain which, in
turn, intensifies the muscle spasms.
An abnormally thick hymen: this anatomical abnormality is quite uncommon.
Inflammation of the outer genitalia (vulva). This is termed vulvitis or vestibulitis.
Inflammation of the vagina (vaginitis)
Vulvodynia: This is a condition of obscure origin whereby the skin around the external
genitalia is very sensitive. In fact, women suffering from vulvodynia will feel sore
around the area even when engaged in other activities apart from sexual intercourse.
When severe, there may be discomfort, even pain, almost all the time.
Most women suffering from primary dyspareunia will be found to have vaginismus.
Causes of secondary dyspareunia
As mentioned earlier, painful intercourse is classified as primary or secondary depending
on timing of onset. For a woman who starts experiencing painful intercourse after
months or years of problem-free sexual experience, she will be said to suffer from
Causes of primary dyspareunia mentioned above can start at any time and therefore
they can cause secondary dyspareunia as well.
Vaginismus described above. It is unusual for this to cause secondary dyspareunia
but is by no means impossible. There are cases of vaginismus which are seen affecting
women who have had a trouble-free sex life previously. Careful history taking will
usually reveal an event or events which might have triggered this. Rape and other
forms of sex abuse come to mind.
Other causes of secondary dyspareunia include:
Pelvic inflammatory disease (PID)
Scarring inside the pelvis. This could be due to previous pelvic surgery or previous
A womb tilted backwards (retroverted uterus). It is important to bear on mind that
the vast majority of women with a backward tilting womb will not have painful intercourse.
However, a minority do.
Sexually transmitted infection: Infections like genital herpes will cause painful
eruptions which are sore and an attempt at intercourse will be painful. This is typically
Scarring at the entrance of the vagina: This is usually a result of poor healing
of a repaired episiotomy or tear sustained during childbirth.
Lack of or inadequate lubrication: This is a problem mainly affecting post-menopausal
women. However, even much younger women can be affected by this. Vaginal dryness
is one of the features of prolonged estrogen hormone deficiency, something that is
common in the post-menopause.