Sexual intercourse is supposed to be an enjoyable experience and it is, for most people. For some women, however, the thought of having intercourse sends them into panic mode. This is because it leads to discomfort and pain. Some experience the pain during intercourse or after sex. The vagina gets sore and very painful and there are many reasons as to why one may experience stomach pain after sex.
This pain, felt either during or after sex, is clinically known as dyspareunia. It’s normal to occasionally experience dyspareunia especially during deep penetration but if the pain is felt often, then there is a problem. The woman can no longer enjoy sexual intercourse and this could lead to distress.
A British survey on dyspareunia and its prevalence and associated factors found that 95% of sexually active women between the ages of 16 and 74 experience pain during intercourse.
According to Dr. Lawrence striker, an associate clinical professor of obGyn at Northwestern University Medical School, dyspareunia can be classified in two: superficial and deep. This classification is dependent on where the pain is felt. Superficial dyspareunia is felt in the tissues around the vaginal entrance (pain on entry) while deep dyspareunia is felt deeper within the penile thrusting (he gets in just fine but there’s terrible pain with every thrust). Stomach pain after sex may have started when the woman became sexually active or develop later in her life.
Stomach pain after sex causes
The causes can either be psychological, physical or a mix of both. Painful sex no matter the cause can result to emotional and physical distress.
Psychological issues include anxiety, history of sexual abuse and relationship problems. The British survey found that pain after or during sex is caused by relationship problems like not feeling emotionally close, lacking the same level of interest, difficulty discussing sexual matters and not sharing the same likes and dislikes.
Other studies have also linked childhood abuse to painful sex. Diseases too also contribute to psychological causes. If one has had an STI before that caused pain, they will associate sex with the disease hence hindering arousal that will, in turn, lead to painful sex.
Physical causes of superficial and deep dyspareunia include:
Skin conditions
This includes allergies to certain products if they come into contact with your skin. They often lead to swelling, pain, redness and itching in areas affected. Some people experience more severe reactions like swelling, difficulty breathing, hives and anaphylaxis, that can be life-threatening.
If your skin has allergies, then you will get pain during or after sex after coming into contact with latex or spermicide in condoms and semen. Other skin conditions include eczema, lichen planus (a chronic recurrent rash that’s caused by the inflammation of the mucous membrane and skin) and lichen sclerosus (a skin problem that affects the perianal and genital areas).
If you have any of these conditions consult a doctor on alternatives. In case of eczema, you and the doctor will identify the irritant that’s causing contact dermatitis and remove it. Treatment can be by using topical steroid ointments and creams. Antihistamines can also be used to relieve itching while ice packs can also be placed on the affected area but only for a short time. We don’t want to freeze the area!
You can treat Lichen Planus and Lichen Sclerosus, using topical steroids ointments and creams prescribed by a doctor. If the problem is internal, steroid suppositories can be used by inserting them into the vagina. Oral treatments are also an option if all other treatments fail.
Endometriosis
This is when cells that line the uterus grow elsewhere in the body. These cells then behave like those in the uterus and have the menstrual cycle. Every month, the cells build up, break down and eventually bleed. Period blood can leave the body through the vagina but not from any other part of the body. This causes painful and heavy periods, depression, tiredness, infertility and sexual problems.
Treatment will depend on the diagnosis by the doctor. He may offer medical treatment to relive pain or surgery.
Infectious conditions
This includes sexually transmitted infections, frequent thrush and UTI’s (Urinary Tract Infections). These are passed on through sex. Thrush, on the other hand, can develop from wearing tight clothes, using products that irritate the vagina or taking antibiotics. For treatment, antifungal tablets can be taken or topical creams applied. This can also be used internally through insertion into the vagina. You can visit the doctor for a prescription or buy them over the counter. Your partner will also need to be treated.
STI’s can be identified from several symptoms including burning, itching, pain, unusual vaginal discharge, pelvic pain, pain when urinating, bleeding during sex and swollen lymph glands. If the upper genital tract, which consists of the fallopian tubes, ovaries and uterus/womb, gets infected (pelvic inflammatory disease) it could damage the fallopian tubes and increase ectopic pregnancy risk or infertility. It’s advisable to, therefore, treat STI’s immediately you notice the first signs.
Cystitis, another term for Urinary tract infections, causes pain in the bladder and pain when urinating. Other symptoms include a need to urinate often, bloody urine, dark urine that has a strong smell and fever. A mild UTI will clear up after a few days but if it’s severe, then it needs to be treated with antibiotics. You can prevent frequent UTI’s by urinating immediately after sex, avoiding products with strong scents or flavors down there, washing the vagina with water only, drinking lots of fluids and staying clean down there.
Fallopian tubes blockage
If the fallopian tubes get blocked, then an egg cannot pass through and fertility becomes a casualty. Blockages lead to pelvic infections transmitted mostly through sex, ectopic pregnancies and pelvic or abdominal surgeries. For treatment, surgery will be required.
Lack of lubrication
This can be due to lack of sexual arousal, some prescription medicines, hormonal problems and pelvic radiotherapy. If non-lubrication is due to lack of sexual arousal, increase foreplay and delay penetration until the vagina is really ready. This will increase lubrication and reduce pain.
Reduced estrogen levels especially after menopause, can cause vaginal dryness. To treat this, one can use hormone replacement therapy. If the hormonal problems are due to a thyroid problem, then the problem can be treated using medication or surgery.
Your gynecologist can prescribe medicine to reduce dryness like oral contraceptives, some high blood pressure medicine or antidepressants. Other alternatives may also be available including use of moisturizers and lubricants.
Cervicitis/ cervix inflammation
Caused by allergies, infections transmitted sexually or sensitivities. There may be no symptoms but if not treated, can lead to other problems. Common symptoms include bleeding and pain after sex and unusual vaginal discharge. Antibiotics can be used to treat the infections.
Vulvodynia
This is a long-term itching or burning pain on the external genitals that has no obvious medical causes. Vulvodynia is of two types; unprovoked, where the pain occurs spontaneously or provoked, that occurs around the vaginal entrance. Pain is caused by either non-sexual or sexual touch. Non-sexual can include inserting tampons, cycling or wearing tight clothes.
To treat vulvodynia, topical preparations are applied to the area. One can also use injections and oral medication. Other remedies include sex therapy and pelvic floor physiotherapy. In case the situation does not change, surgery may be an option.
To prevent vulvodynia, one can:
- Avoid scented products down there
- Do not shave around the vulva
- Use only water or mild soaps to wash the area
- Minimize pressure to the vulva by avoiding cycling and horse riding
- Do not wear tight clothes
- Avoid pools and hot tubs that are chlorinated. If you must, apply petroleum jelly before use
- Go for the girl on top positions during sex because they are more comfortable
- Urinate after sex
Interstitial cystitis/ painful bladder syndrome
Some of the symptoms include a need to urinate more often, getting a sudden strong urge to urinate and severe pain in the abdomen or pelvis. This isn’t caused by an infection and therefore can be a bit tricky to treat. Some of the lifestyle changes one can try include:
- Avoiding certain foods
- Quit smoking
- Limit fluid intake
- Reduce stress
- Regularly empty the bladder
If these do not work, physiotherapy, psychological therapy or surgery can be done.
Vaginismus
Vaginismus is experienced when one tries to insert a penis, tampon or speculum into the vagina. The condition makes these insertions painful. This pain is caused when the pelvic muscles, responsible for intercourse, urination, childbirth, orgasm and bowel movements, involuntarily contract, leading to a muscle spasm.
Vaginismus is caused by physical or emotional stressors or a combination of both. It can become anticipatory. Some of the emotional triggers include performance anxiety, guilt, fear of pregnancy or pain, issues with the partner, trauma or childhood experiences.
Physical triggers include childbirth, conditions like cancer, infections (UTIs), menopause, inadequate foreplay, side effects of medication, pelvic surgery and decreased vaginal lubrication.
Some women experience abdominal pain during orgasm. This could also be caused by a muscle spasm since during an orgasm, the pelvic muscles tend to contract.
Irritable bowel syndrome
Symptoms include spasms that can only be relieved by visiting the toilet. Other symptoms include abdominal pains, diarrhea, constipation, rumbling noises/wind and sharp pains experienced in the back passage. Treatment involves lifestyle changes like eating balanced diets, exercising and reducing stress, medications, low dose antidepressants, medications to stop diarrhea and prevent constipation and physiological therapy.