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Painful Sex (for Women)

Painful sex for women (known diagnostically as Genito-Pelvic Pain/Penetration Disorder) involves persistent or recurrent difficulties with one or more of the following:

  1. Vaginal penetration during intercourse.
  2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
  3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
  4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

Each one of the above problems can occur independently or as a mix of each at the same time.  Difficulties with vaginal penetration can occur in some situations but not others.  For example for some women the problem only occurs during sex but the use of tampons is OK.  While for others any penetration, at any time, for any reason may prove extremely difficult or impossible.  Pain can result from superficial or shallow penetration or only during deeper penetration and sometimes pain can occur even without penetration.

Vaginal pain can be described differently depending on the woman’s experience.  Some women describe it as a ‘blunt’ pain or as ‘stabbing and sharp’.  Understandably, some women avoid sex due to their anticipation of vaginal pain and this can cause relationship conflict.  Tensing or tightening of the pelvic floor muscles during attempted sex can occur as a reflex and is not easily controlled.  However, this tensing or tightening can at other times be under the control of the woman and in response to anxiety or fear of pain expected during penetration.

Like many other psychological conditions, painful sex for women can result in Mild, Moderate or Severe levels of distress depending on the individual concerned.  Other factors include whether the problem is lifelong or acquired.  If the problem has been present since the individual became sexually active it is considered lifelong.  If the problem commenced after some months or years of normal sexual functioning it is considered acquired.

What causes Painful Sex?

Painful Sex for women can be caused either by psychological or physical factors or a combination of both.  A good place to start if you suspect you’re experiencing unusual and persistently painful sex is to speak with your GP or a sexual health physician to determine if there is a physical basis for the problem.  Painful Sex often occurs at the same time as other female sexual disorders including Low Sexual Desire for Women and Female Orgasmic Disorder as the causes for each condition can be inter-related.  Pain during penetration can occur if sex is attempted before a woman has become adequately sexually aroused (e.g., and vaginal lubrication has occurred).  Fear of pain during intercourse can dampen a woman’s desire for penetrative sex and she may become avoidant or reluctant for any sexual activity that may lead to sex.  Some women report feeling sexual desire even though sex is often painful, however in these cases there can still be a tendency to avoid sexual activity in anticipation of pain.  Some women also avoid recommended gynaecological examinations due to avoidance of predictable pain.

Physical causes of Painful Sex:

Painful sex can result from medical conditions including Lichen Sclerosus, Endometriosis, Pelvic Inflammatory Disease, constipation, Interstitial Cystitis or Vulvovaginal Atrophy.  Effective treatment of the above conditions may reduce or eliminate pain during sex.  Declining oestrogen levels after menopause can result in vaginal dryness or vulvovaginal atrophy that may also cause pain during sex.  Unfortunately, painful sex can occur in the absence of an identifiable medical condition and more research is required in this area.

Psychological causes of Painful Sex:

Some researchers have argued that a history of sexual abuse causes painful sex during intercourse in later life.  This may be because sexual activity triggers the same fear or anxiety that was experienced during those times of sexual abuse and this fear hinders sexual arousal resulting in painful sex.  However, many women who experience sexual abuse go on to have pain free sex in later life, so the relationship between painful sex and sexual abuse is unclear.

Painful sex can occur if intercourse is attempted before the woman is sufficiently sexually aroused.  Inadequate foreplay or romantic companionship can result in painful penetration and hence avoidance of sex.  Painful sex also often co-occurs with relationship and marital problems.  A woman’s avoidance of sex due to her anticipation of pain can cause arguments and misunderstandings with her partner.  These arguments can create relationship dissatisfaction and a loss of feelings of intimacy towards her partner, which in turn makes arousal less possible and pain during sex more likely, thus creating a vicious cycle.

How common is Painful Sex?

It’s difficult to determine how common painful sex for women is however some studies in North America estimate that about 15% of women report recurrent pain during intercourse.  Most concerns regarding painful sex are noted during early adulthood when young women first become sexually active and at about the same time as (or after) menopause.  Many women also report painful sex in the months after pregnancy.

What are the steps in treatment for Painful Sex?

The assessment of pain during penetration is often best completed by a gynaecologist or pelvic floor physical therapist.  Physical causes to pain during penetration should be ruled out or managed before seeking the help of a sex therapist.  Once physical causes have been ruled out counselling may involve a focus in several areas.  Relaxation training can play an important role in managing this condition, particularly when the woman has some control over vaginal spasms or tightening.  If the couple is experiencing relationship tension due to their shared sexual difficulties then this is likely to make the problem worse.  Counselling plays an important role in educating couples about the causes of painful sex for women and in managing anxiety or emotional tenseness in the relationship that can complicate a woman’s normal sexual functioning.  Counselling generally aims to help the couple make changes to reduce the likelihood of pain during sex.  Counselling may also focus on keeping the couple intimately engaged and resistant to the detrimental effects painful penetration has on their relationship as a whole.

Disclaimer:  The information covered on this website is for educational purposes only.  A diagnosis of any psychiatric or medical condition must only be made by a medical or mental health specialist.  Diagnosing a psychiatric concern is a complex process that involves formal training, do not ‘diagnose’ yourself.  If you have concerns that a particular disorder or condition applies to you, please speak with your General Practitioner for further assessment and medical/psychological care.

Individual counselling appointments are 50 minutes long.
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