The new Diagnostic and Statistical Manual of the American Psychiatric Association has relabeled pain with partial vaginal entry, during intercourse, and after intercourse as Genito-Pelvic Pain/Penetration Disorder. It is common among women, and many who experience pain have done so since their first intercourse experience (Coady & Fish, 2011; Donaldson & Meana, 2011). When it is severe and ongoing, it is likely to create severe distress in a woman’s sexual experiences (Smith & Pukall, 2011).

A variety of factors can cause vaginal discomfort and pain related to penetration. Discomfort at the vaginal entrance or inside the vaginal walls is commonly caused by inadequate arousal and lubrication. Physiological conditions such as insufficient hor­mones can reduce lubrication. Using a lubricating jelly can provide a temporary solution so that intercourse can take place comfortably, but this may bring only short-term relief. Yeast, bacterial, and trichomoniasis infections cause inflammations of the vaginal walls and can result in painful intercourse. Foam, contraceptive cream or jelly, condoms, and diaphragms can irritate the vaginas of some women. Pain at the opening of the vagina can also be attributed to an intact or inadequately ruptured hymen, a Bartholin’s gland infection, or scar tissue at the opening (Kellog-Spadt, 2006). If smegma collects under the clitoral hood, it can irritate the clitoris when the hood is moved during sexual stimu­lation. Gentle washing of the clitoris and hood can help prevent this.

About 10% of women experience severe pain at the entrance of the vagina known as vestibulodynia, and this may be the most common cause of painful intercourse (Bergeron, 2009). Typically, a small reddened area is painfully sensitive, even to light pressure, but the area may be so small that it is difficult for even a health-care practi­tioner to see. Treatment options include topical medicines and surgery to excise the hypersensitive area (Goldstein et al., 2006).

Pain deep in the pelvis during coital thrusting can be due to jarring of the ovaries or stretching of the uterine ligaments. A woman may experience this type of discom­fort only in certain positions or at certain times in her menstrual cycle, usually during

Sexual Difficulties and Solutions

ovulation or menstruation. If the woman controls positions and pelvic movements dur­ing coitus, she can avoid what is painful. Another source of deep pelvic pain is endo­metriosis, a condition in which tissue that normally grows on the walls of the uterus implants on various parts of the abdominal cavity (Tripoli et al., 2011). This extra tissue can prevent internal organs from moving freely, resulting in pain during coitus. Birth control pills are sometimes prescribed to control the buildup of tissue during the monthly cycle (Reiter & Milburn, 1994).

Gynecological surgeries for uterine and ovarian cancer and infections in the uterus, such as those from gonorrhea, can also result in painful intercourse. In fact, pelvic pain is often the first physical symptom noticed by a woman who has gonorrhea. If the infec­tion has caused considerable scar tissue to develop, surgery may be necessary.