Boston Counseling Therapy

Sexual Pain Disorders: Male and Female Pain During Intercourse: Strategies for Overcoming Dyspareunia and Vaginismus

Portraits

Blair has had a great sex life, and hasn’t experienced real painful sex since she lost her virginity—about 30 years ago. “I don’t want the sex life between my husband and I to be over” she says, but it’s hurting more and more all the time.

“It burns like crazy during intercourse,” says Joel. Is it an STD?

My husband and I like having rough sex. But sometimes it hurts pretty badly afterwards. What can I do to help the problem?

Definitions and Key Thoughts

There are two major classifications of sexual pain disorder, dyspareunia and vaginismus.

Dyspareunia can occur in both men and women and refers to pain in the pelvic area during or after sexual intercourse.

Vaginismus occurs in women only and involves an involuntary muscular spasm of the tissue surrounding the vagina. This causes the vagina to close, which results in penetration being painful, or impossible.

Vaginismus occurs in less than two percent of women.

According to the American Psychological Association, dyspareunia is due to physiological factors at least 75 percent to 80 percent of the time.[i] When psychological and emotional factors are a factor, the problem often involves feelings of guilt or shame about sexual contact, or memories of past sexual abuse.

Vaginal pain during sexual intercourse can be due to a variety of causes including:

• An aggressive or impatient sexual partner
• Premature lovemaking following childbirth or surgery (episiotomy)
• Decreased levels of female hormones during or after menopause (vaginal lining loses its normal moisture)
• Inflamed hemorrhoids
• Genitourinary tract infections (such as a bladder infection)
• Vulvar vestibulitis (inflammation of the vestibule of the vagina—the area of the perineum between the labia minora including the opening of the vagina and the urethra) is among the most common causes of dyspareunia in women, and is commonly overlooked
• Herpes sores[ii]

Note: Vaginal pain at entry that decreases over time is commonly caused by inadequate lubrication. This is often due to lack of sufficient sexual arousal and stimulation.

Male Dyspareunia also has common causes. Pain occurring while obtaining an erection may be associated with inflammation of the foreskin, psychical trauma to the penis, infections, genital allergies, or Peyronie’s disease. The most common causes of pain during male ejaculation are prostatitis and urethritis.

Assessment Interview for Sexual Pain Disorder

If one is experiencing sexual pain, a physical exam should be sought by a licensed physician.

1. When did the sexual pain begin?
2. Is there any time when it is not painful to have sexual intercourse?
3. Has anything helped decrease the amount of sexual pain experienced?
4. Is your sexual partner aware of the pain you feel during sex?
5. Does your sexual partner experience pain during sexual intercourse?
6. Where specifically does the pain occur? (Labia, vagina, glans of the penis?)
7. Do you have any history of sexual abuse?
8. Do you believe that your sexual activity is in anyway embarrassing, shameful, or unethical?

Action Steps and Treatment Plan for Sexual Pain Disorder

Treatment for sexual pain differs depending on the sufferers gender and the root cause of the pain.

For eliminating sexual pain, strategies include:

Patience

Being less aggressive and gentler during the act of sex will allow a female more time for vaginal lubrication.

Sexual foreplay. Stimulation by the hand or oral sex can also be used prior to intercourse to decrease sexual pain.

After a pregnancy or a surgery in the pelvic area, wait at least three weeks before attempting sexual intercourse.

Lubricants

If the problem is associated with vaginal dryness, a lubrication fluid, cream, or gel can be applied to the vagina, or the partner’s penis, to ease insertion of the penis during sex.

Medications

Certain medications can help to relax the vagina during intercourse, can increase sexual hormones such as estrogen or testosterone, and can help change the physical sensation of sexual intercourse.

In some instances, sexual surgery can be an effective treatment for sexual pain disorder in women.

For men; if one is experiencing painful intercourse due to a penile skin infection, or an infection of the urethra, antibiotics can be prescribed by a physician.

If painful intercourse is caused by herpes sores, allowing time for the sores to heal is often the best treatment. A physician may be able to prescribe a medication to promote healing and delay future outbreaks.

Psychological Care

If emotions or psychological issues are a factor, addressing one’s thoughts and feelings about sexual intercourse can be helpful.

Doe the sufferer consider sex to be dirty, shameful, or unethical? Is the sufferer associating sexual intercourse with past sexual abuse? These are just two areas that can be treated through counseling and psychotherapy.

Sexual Therapy for Vaginismus

The American Psychological Association has presenting the following advice on treating the sexual pain disorder vaginismus:

“The treatment of choice with vaginismus is an extensive therapy program combining education and counseling with behavioral exercises. Exercises include pelvic floor muscle contraction and relaxation (Kegel exercises) to improve voluntary control.

Vaginal dilation exercises are recommended using plastic dilators, and should be done under the direction of a sex therapist or other health care provider. Treatment should involve the partner. This should include gradually more intimate contact culminating in intercourse.

Educational treatment should provide information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.”[iii]

Resources

American Family Physician: Evaluation and differential diagnosis of dyspareunia

Kistner’s Gynecology & Women’s Health A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births

National Institutes of Health - National Library of Medicine. Medical management of endometriosis-associated pain

Social Bookmark