• Dr Peter Chew

Endometriosis and pain during sex

I am married for 7 months; I feel pain every time I have sex. What could be the cause? What is the treatment?

Answer: Pain during sexual intercourse or “dyspareunia” can occur at the entrance of the vagina, or deep inside the vagina.

Common causes include

• Endometriosis: a condition due to the backflow of menstrual blood. The pain occurs during deep penetration

• Vaginismus: a condition when there is involuntary contraction of the pelvic muscles at the opening of the vagina. The pain is superficial.

• Vaginal dryness or inadequate lubrication from insufficient foreplay, menopause or during breast feeding.

• Intercourse soon after pelvic surgery or child birth

• Vaginal infection from sexually transmitted diseases such as Chlamydia and gonorrhoea.

• Ovarian tumour or cyst: Pain is experienced if the tumour or cyst is hit during deep penetration.

• Urinary tract infections

• Allergic reaction to condoms, clothing, spermicides or douches

• Genital irritation from soaps, detergents, douches, or feminine hygiene products

Treatment of dyspareunia depends on the cause, which can be elicited by detailed medical and sexual history and physical examination.

• For endometriosis: Endometriotic deposits or cyst should be removed surgically followed by medications to prevent recurrence.

• For vaginismus: Successful treatment can be achieved with appropriate sexual counselling using plastic dilator. Surgery to “enlarge” the vagina is not necessary.

• For painful intercourse in women after surgery or delivery: - Wait for at least 6 weeks after childbirth before resuming sexual intimacy - Be gentle and patient when resuming sexual intercourse.

• For vaginal dryness from inadequate lubrication: - Adequate foreplay and stimulation of clitoris. - Water-soluble lubricant like K-Y Jelly should be used. Vaseline should not be used as it may encourage vaginal infections.

• For genital tract or urinary tract infection, use appropriate antibiotic or antifungal drug.

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