Pelvic Pain

Many women have pain in their pelvic region at some point in their lives. Each woman responds to pain in her own way. Some women are bothered more than others. You should discuss any pain with your doctor if it disrupts your daily life, if it worsens over time, or if you've noticed a recent increase in pain.

Dyspareunia (dis-pa-roon-ia) is the medical term for pain during intercourse. You may hear your doctor use this word or see it in other written material. Pain during intercourse can be caused by a wide variety of reasons. Examples include an allergic reaction to a personal hygiene product or hormonal changes related to aging. Sometimes, emotional issues may also play a role. The Causes of Pain During Intercourse Include:

• Tipped or Retroverted Uterus - Some women with a tipped uterus experience pain during intercourse. This happens when the penis hits the cervix or uterus during sex. This condition is known as collision dyspareunia.
• Endometriosis - The tissue lining the uterus - the endometrium - may grow outside the uterus causing deep pain during sex.
• Infection - Bacterial or yeast infections are among the most common causes of pain during intercourse.
• Lack of Estrogen - During menopause, the vaginal walls thin and the amount of vaginal lubrication decreases.
• Vulvodynia - In this condition, the vulva is hypersensitive and extremely tender on touch.
• Drug Side Effects - Common drugs including those for allergy, high blood pressure or depression may affect the amount of vaginal lubrication, as well as the level of sexual arousal and desire.
• Physical Problems - Scar tissue from abdominal surgery or from delivering a baby can distort the anatomy and cause significant pain during intercourse. A cyst on an ovary can also cause pain.
• Musculo-Skeletal Pain Pelvic Floor - Pelvic floor muscle spasms are involuntary muscle spasms and of the can result in difficult and uncomfortable sex.
• Emotional issues - Sometimes, past issues such as sexual abuse or communication problems in a relationship can translate into dyspareunia.

Vestibular pain is another condition that can give pain with intercourse in women with inflammation of the vulvar/vestibular area. The vulvar vestibule is the area just outside the hymeneal ring. Pain occurs with sexual intercourse, or even inserting tampons. There is distinct tenderness and at times, erythema in the vestibule. In some cases, intercourse is impossible due to the severe pain.

Typically, women with vestibular pain, present with a varying duration of symptoms, from weeks to several years. Symptoms often begin after experiencing some type of infection or trauma followed by difficulty with intercourse. Women with severe symptoms may also feel this sensation when riding a bicycle, horseback riding or jogging. There is a mixed variety of pain where some patients experience these symptoms while sitting, walking or even without any movement.

An initial treatment is to direct the patient in vulvar care. The vulva should be kept dry. Cotton underwear is recommended. No underwear should be worn at night. Vulvar irritants should be avoided. The patient should use mild soaps for bathing and consider no soap application to the vulva. If menstrual pads are irritating, 100% cotton pads may be helpful. Adequate lubrication for intercourse is recommended. If the pain persists then, speak with the doctor.

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