Pain after sex
Q: Dear Dr Mitchell,
I started to feel pain in womb just after sex, then once in a while even when not having sex, and now it is every day. What could this be?
A: Painful sexual intercourse (Dysparuenia) is significant and needs to be fully evaluated because it may suggest significant underlying abnormal changes in the pelvic organs.
This problem may be superficial, in which case the discomfort is experienced at the entrance to the vagina, or it may be felt deep in the back of the vagina. Superficial pain or discomfort may be experienced if there is vaginal dryness, a vaginal infection or situations where the muscles fail to relax because of anxiety or other mental problems. Vaginal dryness may be due to lack of lubrication as a result of inadequate arousal or may be due to low oestrogen levels as is seen in older women who are menopausal or peri-menopausal.
A vaginal infection such as a yeast or bacterial infection may also cause soreness and pain which may be experienced either superficially or deep in the vagina. Pain that is felt deep in the vagina or in the “womb” (uterus) may be due to Pelvic Inflammatory Disease. This infection is usually caused by gonorrhoea or chlamydia and sometimes both organisms in some couples. The infective organism goes up through the cervix and causes the Fallopian tubes to become inflamed. In neglected cases the tubes may even become blocked, resulting in infertility. The ovaries can also become infected forming ovarian abscesses in some cases. This usually presents with fever, pelvic pain and a vaginal discharge and warrants emergency intervention. This is treated aggressively with intravenous antibiotics, and sometimes surgery is necessary to drain the abscess and control the infection.
Endometriosis can also cause painful sexual intercourse. This is a condition where tissue similar to that which lines the uterus is present outside of the lining of the uterus and results in pain before the menstrual period, during the period, and after menstruation. If left untreated it can cause chronic pelvic pain and pain during sexual intercourse. Treatment is usually in the form of drugs that are used to stop the menstrual period such as the combined oral contraceptive pills, contraceptive injections or other medications that suppress the menstrual period.
An ovarian cyst and uterine fibroids can also cause pelvic pain, which may be aggravated by sexual activity.
You need to consult your doctor and have a pelvic examination, Pap smear and ultrasound done. If there is evidence of an infection then this should be treated promptly. Your sexual partner should also be treated to reduce the risk of recurrence.
A cervical swab should be done to determine if gonorrhoea or chlamydia are present, and appropriate antibiotics should be given to cover these two infections. Consult your doctor who will advise you further.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.
DISCLAIMER: The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
