Pain during intercourse
Pain during intercourse is a common complaint among female students. In a health study on university students in 2016, 13.9% of women aged under 35 years and 15.5% of women aged 22 to 24 years reported having experienced pain during intercourse within the past month.
Pain during intercourse may be caused by infection in the genital region (yeast infection, bacterial vaginosis, chlamydia, gonorrhoea, herpes), dryness of the vaginal mucosa (among students mainly due to the contraceptive pill or the acne medicine isotretinoin), mucosal conditions (such as lichen sclerosus), vaginismus (contraction of the pelvic floor muscles), rare anatomical abnormalities, or vulvodynia.
Vulvodynia refers to persistent pain in the opening of the vagina. It occurs in conjunction with attempted penetration with a penis or an object (vulvar vestibulitis syndrome). In some patients, the pain is continuous (dysesthetic vulvodynia). The pain is often described as burning, stinging or sharp. Symptoms of vulvodynia often appear after recurrent urinary tract infections or yeast infections. However, there are also patients who’ve always had pain ever since their first attempts to use a tampon.
The cause of vulvodynia is not known. It is, however, known that patients with vulvodynia have more sensory nerve endings in the mucosa of the pain site than patients who do not have pain. These nerve endings erroneously sense even a gentle touch as pain. Vulvodynia very often involves vaginismus, i.e. contraction of the pelvic floor muscles.
Vulvodynia is diagnosed with a cotton swab test during a gynaecological examination: the opening of the vagina is touched with a moisturised cotton swab to look for potential trigger points for pain. Before diagnosing vulvodynia, other causes of intercourse pain (infections, skin conditions) should be excluded.
Apply skin oil obtained from the pharmacy on the sore areas in the evenings, using a mirror if necessary. This also has a desensitising effect, the idea being to make the trigger points for vaginal pain used to touch and consequently to reduce pain sensitivity. Identifying the pelvic floor muscles and performing relaxation exercises for them may help to control the pain. Lubricants and numbing gels may make intercourse easier.
Instructions for vulvar skin care
Washing the vulva
Use water only. Avoid soap and scented washing products. Dry the skin by patting it gently with a towel. Avoid scents or sprays in the vulvar region. Use sanitary pads during your period for as short a time as you can.Avoid high-absorbency pantyliners, as they contain chemicals that may worsen the irritation. After washing the vulva, you can use liquid skin care cream to reduce mucosal dryness and irritation.
If intercourse is painful, use a small amount of non-irritating liquid skin product as a lubricant. If the pain is severe, apply a small amount of numbing cream or gel to the opening of the vagina.
Use cotton underwear to reduce skin irritation. Change your underwear every day. Avoid tights and tight trousers that may cause chafing.
Use laundry detergents that do not contain coloring agents, scents or enzymes. Avoid softeners and stain removers, as they may irritate the skin.
Avoid exercise that chafes or irritates the genitals such as riding a horse, cycling, or swimming in water with a high chlorine content. Muscle relaxation reduces pain.
When should you seek treatment?
If self-care fails to ease the symptoms, contact a healthcare professional. Vulvodynia can be treated both with physiotherapy and with medication.
Information sources: Duodecim Terveysportti, Lääkärin tietokanta database, Sairaanhoitajan tietokanta database, YTHS General Practitioner
FSHS General Practitioner / 12 October 2019