One of the most common gynecologic complaints among women during their reproductive years is pain during sex or dyspareunia. It accounts for 8-22% of visits to gynecologists and requires empathetic and complex evaluation, diagnosis, therapies, and counseling sessions. Pain during sex can begin with initial penetration, with thrusting, or a combination of the two. Pain during sex can be a result of anatomic variety such as size, shape, the orientation of reproductive organs, nerves, and muscle development. Hormonal changes, underlying infections or diseases, and emotional factors can all impact a woman's ability to enjoy sexual intercourse. Likewise, a partner's anatomy and technique can affect whether a woman can experience the pleasure of sexual intercourse.
Anatomy Affects Pain During Sex
The length of a woman's vagina and the direction that the uterus is tipped (forward or backward) can be one reason for pain during sex. Shorter vaginas and a uterus that is tilted towards the rectum are more common anatomic factors that can cause pain. One of the easiest ways to classify the different reasons for painful sexual intercourse is to divide the pain into 'initial penetration' pain and 'deeper penetration' pain. For instance, women who have pelvic organ prolapse such as a dropped bladder or uterus (which is uncommon unless the woman has had multiple pregnancies) can cause both initial and internal pain during sex. If a woman has a short vagina, the man needs to adjust his depth of thrusting or in the case of a backward tipped uterus; he would need to aim more towards the anterior part of the vagina towards the bladder and not towards the rectum. There are areas around the cervix that cause less pain and directly hitting the cervix can be very painful especially if the woman has had surgery to the cervix or a history of cervicitis. Cervicitis is an inflammation or infection due to vaginitis or sometimes sexually transmitted diseases such as pelvic inflammatory disease (PID).
Hormonal Causes of Painful Sex
During certain days of a woman's cycle like the time right before menstruation, the vaginal tissue may be drier due to the rise of the hormone known as progesterone. The blood vessels around the uterus can swell during this period and produce a throbbing sensation known as 'pelvic congestion syndrome' that can make sex painful. Certain medications such as birth control pills and nursing can change the lubrication levels in the vagina which can make sex painful or less enjoyable. The reason for this is that nursing lowers the estrogen levels, the hormone that causes the necessary arousal juices. An autoimmune condition known as Sjogren's Syndrome results in oral, vaginal, and eye dryness and sometimes the first symptom is vaginal dryness. Water-based lubricants are helpful but do not last very long. Silicone lubricants are longer lasting and have less risk of causing sensitivity. Sliquid brand has an organic line as well as silicone based versions.
An old favorite to help vaginal lubrication and improve pleasure with sex is extra virgin coconut oil. As a gynecologist, I do not recommend them. They can cause biofilms which are slick membranes that can cause bacterial vaginosis which is a vaginitis that results in a fishy discharge and irritation that is difficult to eradicate even with antibiotics. The link below is an easy-to-read article describing all sorts of facts about lubricants and lists some organic lubricants.
Diseases or Conditions That Can Cause Pain During Sex