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Pain during sex is much more frequent than is thought. It is not only a female complaint. Sexology uses the word 'dyspareunia', which literally means 'unsuitable partnership'. Pain nearly always has an adverse effect on the experience of pleasure, and can lead to avoidance of sexual contact.
Pain can be acute or chronic, occur in different locations of the genital area, and at different times during the sexual response cycle: at the onset, and during or after intercourse.
Pain during sex: the female
Vaginal pain may be due to an infection of the vaginal wall, the urethra or the bladder.
If the pain occurs deep inside the vagina, it may be caused by an infection or other problem in the pelvic muscles, the uterus, or the rectum.
If -as is most often the case- the pain occurs at the opening of the vagina, several causes may be distinguished, the first of which is tenseness of the muscle around the opening. This complaint is fairly common among beginners, and those who are (un)consciously afraid of being penetrated. See under vaginismus.
Other causes of pain in the vaginal mouth are an intact hymen, irritation of the skin by insufficient or exaggerated hygiene (do not use soap), candida infection, an sti (sexually transmittable infection) such as trichomonas or herpes, or an allergic response to rubber (latex) condoms.
Painful entry of the vagina may also be caused by the female's pubic bone having such a shape and size that it slightly overhangs the vaginal entrance. An inexperienced male may hit his penis against it, thinking it is the entrance of the vagina (which is, in fact, lower down) and cause pain, even after entering the vagina properly but causing friction between the sensitive skin and the front part of the pubic bone called 'symphysis'. One solution to this problem is for the female to raise her legs all the way up and even backwards (see illustration).
During menopause, the vaginal wall tends to become thinner, dryer and more sensitive, which may be an explanation of pain in women of a certain age. Adequate stimulation and enjoyment as well as the use of a good lubricant can help avoid complaints.
Pain during sex: The male
Men have fewer complaints about pain than women, but pains do occur and can be just as crippling as in women. Causes are various:
Lack of hygiene. Young men who have not learned to clean the head of their penis regularly, may find their first intercourse impossible or unbearably painful, because they are unable to withdraw their foreskin. The cause is adhesion of the foreskin, which has become stuck to the glans by a layer of 'smegma' (discarded skin cells of glans and foreskin). They have to practise moving the foreskin back little by little, while cleaning it with warm water every day. It may take some time, even months, before the foreskin can move freely over the head of the penis.
Circumcised men do not have this problem, of course.
Another well-known cause of pain in young men is a short 'frenulum', the tiny muscle attaching the foreskin to the shaft of the penis. Pulling the foreskin back all the way, especially if it is done with force, e.g. entering the vagina or being masturbated by an inexperienced partner,cause a great deal of pain, and even bleeding. After it is cured, there may still occasionally be the feeling of pain. Young men can also be preventively helped by a small operation.
Another cause of pain is 'phimosis' or a foreskin that is too narrow or rigid. A small operation is necessary to put this right.
Pain can also occur during ejaculation. It may be caused by pressure built up in the prostate gland due to sustained suppression or holding up ejaculation.
Older men can feel pain during orgasm as a result of low testosteron content in the blood.
Also pain can be caused by tension in the pelvic muscles that are involved in the sexual response cycle. Exercising and learning to relax these muscles may bring some relief.
Finally, a pain may occur after ejaculation into the vagina, if the vaginal content is highly acid. The penis cannot bear to stay inside and its gland looks red and the foreskin is swollen. The solution is to bring down the acid content of the vagina, or use a condom.
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