Sexual intercourse pain: causes, symptoms and solutions

Vaginismus and dyspareunia are two sexual disorders that can cause discomfort and pain.

Vaginismus and dyspareunia are sexual dysfunctions where pain is the protagonist. The scarce sexual education and the lack of body knowledge seriously hinder the detection and expression of both problems.

The result is a continuous alert that keeps the affected person away from intimate relations, a fact that translates into a silent suffering. This week, Yolanda Segovia, psychologist collaborating with the Instituto de Asistencia Psicológica Mensalustalks to us about these two dysfunctions and opens a reflection on the importance of their treatment.

What is the difference between Vaginismus and Dyspareunia?

Vaginismus is the impossibility of achieving vaginal penetration due to contraction of the muscles surrounding the entrance of the vagina. When a woman becomes sexually aroused, she experiences a relaxation of the vaginal muscles. However, in Vaginismus, the Muscle contraction is such that it prevents penetration.

Dyspareunia, on the other hand, is the pain that both men and women may experience in the pelvic area during or shortly after sexual intercourse. The pain occurs at the moment of penetration, erection or ejaculation.

Focusing on the female sex, the pain factor is the protagonist in both problems. Even so, the difference is important. In the case of women with Vaginismus, the reflex response of the muscles makes penetrative intercourse impossible (or extremely difficult). In the case of women with Dyspareunia, the pain seriously hinders pleasure during penetration but does not prevent intercourse.

In the case of Vaginismus, what aspects prevent the relaxation of the musculature?

Women with Vaginismus associate penetration with the sensation of danger.. This creates a totally automatic tension response that materializes in the vaginal musculature. This reaction generates a high level of discomfort since there is a desire to maintain a sexual relationship with penetration, but the physical reality is very different. A contradiction then appears between mind-body that is inexplicable for the person.

The result is an overwhelming feeling of lack of control and an explosive increase in anxiety. Among the factors that can cause Vaginismus are sexual beliefs and values that create confusion, insecurity and, inevitably, generate a maladaptive response. On the other hand, this dysfunction usually begins in the past.

Some women report having difficulties during the first menstrual period when they want to insert a tampon, irrational ideas about penetration or the possibility of becoming pregnant, and even distorted ideas about the perception of their own genitals.

And in the case of dyspareunia, why does it appear?

Among the aspects that may influence the onset of pain are insufficient lubrication due to lack of erotic stimulation, vaginal dryness, premature sexual intercourse after surgery or childbirth, genital irritation by soaps, allergies to latex diaphragms or condoms, and those aspects specifically of a medical nature (phimosis, frenulum, prostatitis, hemorrhoids, genital herpes, etc.).

We would like to emphasize that, in the case of this dysfunction, the pain must be constant and repeated during sexual intercourse.occasional pain does not mean that there is a problem. Be that as it may, there is no doubt that discomfort greatly affects sexuality and can lead to avoidance of intercourse.

For this reason, if in doubt, it is advisable to consult a professional.

Do people who suffer from Vaginismus or Dyspareunia talk about their problem?

Most of them do not, they make it a taboo subject. In the case of women with Vaginismus, educational work is especially important. The lack of awareness about one's own body (usually there is no exploration) and social censorship, make the expression and normalization of sexual aspects even more difficult..

This reality distances the affected person from different contexts (friends, peers, family, etc.) for fear of being misunderstood and labeled as "weird". The fear increases day by day and the alertness becomes an intrinsic element of the personality.

From Psychotherapy, what work is done in both cases?

In addition to the psychoeducational work and the detection of negative and destructive thoughts that is carried out in the context of individual therapy, the work that is carried out in couple therapy is also important. To solve the problem it is essential to establish open communication in order to express discomfort and find mutual understanding.

Likewise, the therapeutic work that facilitates change will be aimed at addressing, in a progressive way, deep aspects of the couple's relationship.. The work of introspection, insight and emotional self-expression will accompany us throughout the process. Feelings of guilt, internal conflicts and, in some cases, unresolved feelings resulting from past traumatic experiences (e.g., history of sexual abuse, mistreatment, or rape), will be some of the issues that, from a systemic and integrative perspective, we will repair.

What advice would you give to people who suffer from one of these two dysfunctions?

Especially, in the case of Vaginismus, the sensation related to the lack of control contaminates the rest of personal contexts. The discomfort goes beyond the purely sexual boundary and translates into a fear that goes much further.

The impossibility of having sexual relations with penetration, even if one feels the desire to do so, gradually reduces the ability to have sexual relations with penetration.The impossibility of having sexual intercourse with penetration, while still feeling the desire, gradually diminishes the ability to seek pleasure and satisfy one's own needs. To leave this problem aside can have serious repercussions on the woman's self-esteem. Fear translates into more fear; that is why it is difficult to talk about the problem and consult a professional.

Our recommendation is always to approach the problem from a holistic point of view and, above all, to consider possible organic causes. Once discarded, the work from individual and couple psychotherapy is the one that will help the person to regain self-confidence and, above all, not to live in a continuous struggle, thus gaining control of the situation and stop "escaping".

In this sense, couple communication is essential to reaffirm the right to express and empty all that accumulation of feelings that, in an unconscious way, one day were reflected in an essential organ.