Intercourse Pain

WHEN TO SEE YOUR DOCTOR

* You have recurrent pain with intercourse.

* The pain is preventing you or your partner from enjoying sex.

* The pain is deep within your pelvis and is severe.

* The pain is accompanied by vaginal itching, discharge or dryness.

* You are also experiencing burning with urination.

What Your Symptom Is Telling You

Not tonight, dear." You never thought you'd find yourself saying it quite so often. And it's not a headache that's lessening your libido these days. It's that sex is hurting—and you're not sure why.

Often something as simple as an unaccustomed sexual position will bring on pain. If it's only a twinge with a new position, don't worry—just mention it to your doctor at your next checkup, says Roger Smith, M.D., a professor of obstetrics and gynecology at the Medical College of Georgia Hospital and Clinics in Augusta.

Sometimes simple body mechanics can cause pain during intercourse—dryness or perhaps a small (or tense) vaginal opening. And emotional causes are important, too—if sex has become too rushed and stressed to savor, that may contribute to lack of lubrication and pain.

If the pain you feel is mostly on insertion, the most common causes are an inflammation or infection of the vulva or outer vaginal lips. If it hurts more when the penis is thrusting deeply, then a vaginal infection may be the problem.

A bladder or urinary tract infection is also a possible cause of painful intercourse.

Symptom Relief

Pain with intercourse is not dangerous to your health, says Dr. Smith. But that's no reason to put up with it. Here's how to help bring pleasure back to lovemaking.

Re-position your positions. "You don't need a trapeze bar in the bedroom," Dr. Smith says. Even a slight change in position may help. "The best positions are where the woman controls the thrusting, whether she's on top or you're lying side to side," he says. "Find positions that are comfortable for you both, both mechanically and psychologically. If you can't find a pain-free position, tell your doctor which positions hurt most and which least. This information will help your doctor find out where to look for the problem."

Relax, don't rush. "If your vaginal muscles are tightening up and preventing intercourse, focus on gentle foreplay," Dr. Smith suggests. Often your sensitive body will respond clearly to emotions—like fear of pregnancy or pain or reluctance to have sex. Don't allow yourself to be rushed, and if your concerns persist, talk to your doctor about them. "Making love doesn't have to include sexual intercourse," Dr. Smith reminds us. "You can be tender and loose, and do things like brush each other's hair for an hour."

Quench the dryness. As you approach menopause, thinning and drying vaginal tissues are a common problem—with several solutions. If you feel dry only occasionally, try a water-based lubricant like K-Y Jelly or Surgilube. For continuing moisture, try one of the newer products like Replens, which brings fluid steadily into your vaginal tissues, suggests David Eschenbach, M.D., professor and chief of the Division of Gynecology at the University of Washington School of Medicine in Seattle. If the problem's chronic, you may want to discuss estrogen replacement therapy with your doctor.

Prevent bladder infections. If burning sensations occur during intercourse and urination, it's very possible that you have a urinary tract infection. Once your doctor has examined you, diagnosed a urinary infection and prescribed appropriate treatment, the most important part—preventing repeat infections—is up to you. "Urinate at regular intervals of no less than every three to four hours," says Jack Lapides, M.D., a urologist in Ann Arbor, Michigan. Otherwise, your bladder may stretch, retain urine, become inflamed and be invaded by bacteria.

Heal the herpes. If the herpes virus is at the root of your pain, you should avoid having sex until the outbreak is past. Although herpes needs long-term treatment, it can be urged into remission and even cured, says R. Don Gambrell, Jr., M.D., clinical professor of endocrinology and obstetrics and gynecology at the Medical College of Georgia Hospital and Clinics in Augusta. Your most important cautions during those painful episodes are to "avoid sex during outbreaks and use condoms at all times," he says. (For more information on dealing with vaginal infections, see Vaginal Itching on page 587.)

See also Vaginal Dryness