Dyspareunia or Painful Intercourse

Intercourse pain can be totally debilitating. Complaints range from pain at initial penetration, to pain at deep penetration, to a combination of the two. While physicians can give varying primary or accompanying diagnoses, there is little doubt that the pain is of "mechanical" cause. In fact, the pain generally comes from adhesions or scar tissue left by a prior surgery, inflammation or trauma. In some cases, this is accompanied by an anteverted (forward tilting) tailbone.

During the course of life, the female reproductive tract may be subjected to numerous traumas, infections, inflammations, and surgeries, which can lead to adhesions and scar tissue. Some women absorb these repetitive traumas and stresses to the pelvis without experiencing symptoms or negative side effects. However, some women experience significant, long lasting symptoms including anorgasmia (the inability to have an orgasm or reach a full orgasm), decreased desire (libido) and dyspareunia (intercourse pain).

Endometriosis and adhesions are major causes of painful intercourse. Painful sexual intercourse is a condition that plagues millions of women worldwide. For some, the pain may occur at first penetration. This is often a very sharp and specific pain in one location, often at or near the opening of the vagina. For others, the pain is experienced at deep penetration. This is often described as a broader, deeper pain, and has been described as if “it feels like my partner is hitting something” and in many cases, he is (see picture). Some women may even experience a combination of the two.

Surgery or a fall can pull your tailbone forward, creating a physical block in your body. This can cause chronic constipation,
or pain during intercourse. In cases of pain or tightness at the opening, we find that adhesions, tiny or large, have formed at some time in the past. As the body heals from infection, inflammation, surgery or trauma, it develops tiny adhesions, which are often invisible to the naked eye. These adhesions can form on the surface of the labia, at the vaginal opening or within its delicate inner tissues. These adhered tissues are stretched at the commencement of intercourse, creating a pull on nerves and other sensitive structures. This pull causes pain at just the time when you should be experiencing great pleasure. The irritation can cause pelvic spasms, which in turn causes more pain and dysfunction, perpetuating the process.

Pain at deeper penetration is often associated with a trauma or repetitive stress to the tailbone (coccyx), generally caused by a fall on the hip, back, or tailbone. Other causes may include pelvic surgery (such as an appendectomy or D&C), inflammation (such as endometriosis), or infection (bladder, yeast, etc.). Abuse and repetitive stresses (such as sitting for long periods of time) are other common causes of this pain. When any of these occur, internal tissues may shorten, pulling the tailbone out of its normal position. The tailbone then acts as a physical block to your partner during intercourse, causing you to experience a deep pain during or after sex. Similar conditions can occur at the cervix, or other vaginal tissues.

Intercourse should be a time of great pleasure. Because the female reproductive organs are susceptible to adhesions and tailbone trauma over time, intercourse can become a time of pain and embarrassment. Our endoscopic surgeons at the Aesculap Academy, Mumbai (www.testtubebabyclinic.com) have with pelvic adhesiolysis & peri-rectal dissection of endometriotic implants, decreased pain, increased sexual function, and restored the pleasures of intimacy and intercourse for most of the women we treat with intercourse pain. In doing so, we enrich their lives and those of their partners.