People have sex for all kinds of reasons: the biologic drive to procreate, to foster a sense of intimacy or for simple physical pleasure. Sometimes sex is used as an emotional crutch or to provide psychological reassurance. No matter what the reason, the goal of sex is some kind of gain or reward. Unfortunately, this gain is often accompanied by unpleasantness for some people -- and not just in the "Why hasn't he called yet?" or "Why does it burn when I pee?" kind of way. For some people, usually women, the act of sex can be downright painful.
There are several reasons sex can be painful. The most easily solved cause of painful sex is lack of preparation. While secretion of vaginal fluids and sexual arousal in women are certainly related, sometimes the mind is ready for sex before the body is. A little more foreplay or a little outside assistance in the form of lubrication from a bottle easily helps things along. People frequently underestimate how much lubrication they need or are reluctant to use something so messy, which is why this is such a common problem.
Dyspareunia (literally "bed partners not fitting together" in Greek) is the gynecological term for pain during sex and it can have a variety of causes. Sometimes the source of the pain is identifiable and directly treatable; other times it's not. Pain that occurs with deeper penetration may be linked to a distinct cause, such as endometriosis (the growth of the uterine lining tissue outside the uterus, e.g., affixed outside the ovaries or intestines) or fibroids (benign tumors in the wall of the uterus -- a very common condition). Often, these problems are easily treated, and the pain recedes.
Other times, especially for pain that occurs with early or incomplete penetration, the cause may not be quite as easy to pinpoint. It has long been assumed that pain without an identifiable cause was psychological. Recent studies have shown that in many cases, vulvar vestibulitis syndrome (defined as pain without an underlying cause at the entrance of the vagina) is caused by minor tissue inflammation or irritation. When any area of tissue is inflamed, nearby cells release chemicals that trigger nerves to register pain. This system works when something such as an injury or an infection is actually irritating those nerves -- pain is good when its presence serves as an alert that all is not well. This system fails, however, by increasing sensitivity. This is known as allodynia, the phenomenon of feeling pain in response to a non-painful stimulus. In the case of intercourse, for instance, the system interprets rubbing as pain. There are products, such as anesthetic or anti-inflammatory creams or gels, that can relieve this pain, although some of these products can also cause allergic reactions, especially on sensitive mucosal tissue.
A similar and frequently overlapping cause of painful intercourse is vaginismus, which is intense, involuntary contraction of pelvic muscles, making inserting anything into the vagina difficult or even impossible. It is usually associated with pain, although occasionally it is not. For some women, this can be so severe that it prevents even the use of tampons. The cause can be physical, such as an infection or an injury, or it can be psychological, such as a response to sexual abuse or rape. Regardless of the cause, the cycle of pain during intercourse -- fear of pain the next time, then another painful experience -- keeps going on.
The good news is that vaginismus can be treated -- and with high success rates. Systematic desensitization therapy usually involves a woman practicing gradual and controlled insertion of her own fingers. Coupled with behavioral or psychological therapy, it ensures the woman is ready to and wants to have sex, thus curing simple dyspareunia without an obvious physical cause or vaginismus.
Painful sex is common and can in many cases be easily corrected. (Remember: lube, lube, lube!) Even in cases with a deeper problem, treatment is possible and available. Sex is a topic already fraught with angst; physical pain need not contribute to that angst.
Anna is a University Medical student. She can be reached at asedney@cavalierdaily.com.
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