The causes of Pain during intercourse may be due to

• Dyspaerunia
• Vaginismus

Dyspaerunia
The pain due to Dyspaerunia may occur repeatedly either before, during, or after sexual intercourse. It is one of the common problems in women. It can be primary or secondary, it may also be classified superficial or deep, or as diffuse with every partner or situational i.e. with particular partner. In one study approximately 9% women suffer with pain during sex. In many cases it disturbs the family life also. This vaginal/ genital pain may occur due to various below mentioned causes.

How common erectile disorder is?
In a survey in USA (1994) 39% of 40 Yr. old men, 67% of 70 Yr. old men complained of some degree of impotency. Complete erectile failures were present in 5% at age of 40 Yr., 15% at age 70 Yr. In India 1 in every 10 men suffers from some degree of impotence.

Causes may be

Hormone disorder: In which female hormones are less some other sex stimulating hormone are disturbed. These hormone disorders may be due to any of the following causes: Hypothalmic idiopathic hypogonadotropic hypogonadism, Prolactinomas, Empty sella, Sheehan syndrome, Panhypopituitarism, Inflammatory /infiltrative

• Infections: in genital tract or vulvae vestibule, vulvo-vaginitis.
• Less lubrication due to various reasons as hormone deficiency.

Vaginismus
Painful involuntary contraction of vaginal introitus i.e. opening & vaginal all.

• Sexual aversion disorder.
• Connective tissue diseases leading to dryness.
• Psychological problems: as depression & other psychiatry disorders
• Sex centre disorders so that proper signal of sexual excitation does not comes from the sex centres so that pre sex secretion does not occurs.
• Sicca syndrome
• Idiopathic.
• Neoplasms of vagina.
• Any ulcerative lesions of vagina as chronic lichen planus, herpese genitals.
• Decreased blood supply to vagina due to various medical conditions can lead to diminish vaginal lubrication, pain during intercourse.
• Vulvar vestibulitis.
• Restrictive upbringing, Inadequate sexual information, early insecurity in psychosexual role.
• Vaginal stenosis, vaginal scarring, post surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum.
• Idiopathic vulvodynia.
• Atrophic vaginal mucosal atrophy.
• Sexual aversion disorder & female sexual arousal disorder.

Primary Cause of pain during sexual intercourse

Due to any of the above causes patient may first time feel pain during sexual act. Once a women get pain due to any of the above causes as hormone disorder or decreased pelvic blood supply or any other cause virtually all woman develop following three things, these three factors further worsen the pain during sexual activity, and these are called secondary factors. These secondary factors are as follows:

• Fear of pain: In this the moment lady thinks of going for sex, She starts fearing that, I may get pain again thus she start getting anxious about pain during sex. This fear decreases her confidence leading to further worsening of the pain. Many times due to this fear patient starts avoiding sex & his desire for intercourse decreases.
• Anxiety due to anticipation of pain: Woman develops severe anxiety before real sex. Patient develops obsessive concern for pain during sex i.e. whether or not She can do the sexual activity without pain & can keep his partner satisfied. This performance anxiety can be cured by sex therapy in few sittings.
• So by sex therapy, the patient is taught how to avoid fearing and become free of fear of failure & performance anxiety.
• So above secondary problems hinder into normal recovery of sexual function even if the original cause may have been cured.

After correcting primary cause also sometimes pain during se does not disappears, because these secondary factors interfere with normal sexual functioning. If these factors are also removed by sex therapy, sexual functioning soon becomes normal. The new, intensive team treatment of sexual dysfunction has revolutionized sex therapy. In most cases, for cure of pain during sexual intercourse detailed sex counseling & sex therapy is necessary.

DIAGNOSIS OF CAUSE Of PAIN DURING SEX

First step in proper treatment of pain during sex is accurate diagnosis of cause of her pain during sex. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.