Pain during sexual intercourse can be very distressing to a women. It can hamper progress in one’s sexual relationship. Pain during sexual intercourse should always be brought up with your doctors.

Sexual intercourse especially initial penetration can be slightly uncomfortable but it is not normal for a woman to be experiencing pain that makes her dread having sex.

Where Is The Pain?

• Pain during sex can be experienced

  • at the entrance of the vagina or around the vulva OR

  • deep within the abdomen or deeper within the groin area can also be experience

It’s either a purely external painful experience or a deep internal pain.

What Does External Pain Mean?

Pain at the entrance of the vagina or around the vulva can be caused by:

• Vaginismus

  • Where full or even partial penetration is impossible. It’s a condition where the vaginal muscles spasm involuntarily in response to triggers like fear and anxiety causing a difficulty in penetration

• Imperforate Hymen

  • The hymen is a thin layer of tissue that covers the entrance of the vagina. As a girl ages the hymen becomes perforated and then fully opened. In some girls this fails to happen. This then creates physical obstruction to penetration hence making sex painful. For these girls a minor surgery called a hymenectomy to artificially open the hymen is recommended.

• Genital skin conditions – chronic rash can also occur over the genital area

  • This includes rash from conditions like

    • Eczema

    • Psoriasis

    • Lichen sclerosis

    • Tinea Corporis – which are fungal infections of the genital area

    • Xerosis – which refers to dry skin

• Vulvodynia

  • This refers to persistent vulvar pain without an obvious identifiable cause.

  • Remember, several different organs in the pelvis like the intestine, the ovaries, the uterus, the bladder and the pelvic floor muscle all share similar nerves that also supply the vulva and the vaginal entrance. Pain from these organs can be perceived as pain at the vaginal entrance

• Hormones

  • Major culprits are Birth control pills and contraception that contain only progesterone. They cause reduced lubrication and increased dryness and the vagina and vulva

• Menopause – low estrogen state also cause vaginal dryness

What Does Internal Pain Mean?

Pain deeper in the pelvis can be caused by:

• Pelvic congestion syndrome

  • You’ve heard of varicose veins in the legs, similarly women can have these engorged swollen varicose veins in their pelvis

  • Common risks this include prolonged use of hormone replacement therapy and after childbirth.

  • Most women with this complain of a constant heavy sensation in their groin or pubic area

• Endometriosis

  • This occurs when there is reflux flow of menstrual blood and the shedded uterine lining out through the tubes of the causing spillage into the pelvic cavity.

  • Deposits, scar tissues and unpleasant stringy fibres then start to form as a result of this spillage

• Muscle tightness

  • We call this myofascial trigger points. Muscle in your pelvic floor can tighten up to a point causing “knots” in these pelvic floors muscle.

  • Just as you would undo tight muscle knots in your back with massage and with physiotherapy, likewise pelvic floor physiotherapy which involves a finger examination of the vagina followed by pressure applied to specific points of the vaginal wall to release these tight points.

    • Electro ShockWave Therapy (ESWT) can be very useful in treated this type of chronic pelvic pain.

• Space occupying large masses

  • these include things like large fibroids, tumours, cancers or a bulky uterus caused by a condition called adenomyosis

When you visit your doctor for pelvic pain ensure that your examination is thorough.

Your doctor should performed an external genital check, a vaginal examination with a speculum device to look into the vaginal vault and the cervix, a vaginal examination with fingers, a bimanual examination where the doctor has one finger in the vagina and another hand over the abdomen to properly assess the uterus and surrounding structures.

Don’t suffer in silence.. speak to your doctors or you can see us at InSync Medical where our female doctors are ready to serve you.

Our Female Doctors are ready to listen to your issues. Visit us at InSync Medical Located along East Coast Road in the heart of Katong, Singapore.