There are two different types of pain during penetration, that which occurs at the entrance of the vagina and that which affects the bottom of the vagina. The first is more related to lubrication and the second is more related to a disease called endometriosis.
In his email he tells us that he is 75 years old, so it is most likely an entry dyspareunia. That is the medical term for pain during sexual intercourse, due to reduced lubrication and tissue atrophy after menopause. In the same way that with age the skin dries and wrinkles; That is, it atrophies, and the same thing happens in the skin of the vagina: this makes it more fragile. There are times when this causes some women to spot after intercourse. It’s as if you give constant friction to the skin of your hand: in the end it turns red, irritated, annoying. Well this is similar. And it all has to do with tissue atrophy and vaginal dryness.
If this happens regularly to a young woman, the cause may be that she does not lubricate properly or that she has lacked foreplay to lubricate her sufficiently; If it is new, the most common thing is a fungal infection. But in an older woman, the usual thing is that lubrication is decreased because she lacks hormones after menopause and to this is added the genital atrophy typical of age, so the vaginal entrance orifice is narrower and the skin is weaker. All of this is annoying and makes penetration difficult.
The solution is to use gels and moisturizing creams for the vagina. When the atrophy is very marked, the woman may need some hormones, even if only locally applied for a time. The usual lubricants that many people use do not solve it because, if the atrophy is very marked, they do not correct it. That is why gels with some hormones and perhaps, during intercourse, a lubricant are used.
When there is deep dyspareunia, pain at the bottom of the vagina, the first thing to frequently rule out is endometriosis. Although it can also be due to other diseases, for example, you can have a fibroid in the uterus and what happens is that the penetration collides with the fibroid, or an ovarian cyst of another type, or an inflammation in the tubes. Although the most characteristic thing is that it is due to endometriosis.
This disease occurs when the mucus of the uterus, the endometrium, is placed in places that do not belong, most frequently on the ovaries. And what happens then is that every time the woman to whom this happens has her period, the period comes out, as is the normal situation, but also, since the endometrium has been placed over the ovaries, the blood accumulates in the ovaries. And this forms cysts, which we call chocolate cysts because they are brown due to old (oxidized) blood. As a consequence, every time a woman has her period she feels pain in her pelvis and, when there is penetration, the penis collides with these cysts and causes a lot of pain. The general characteristic in women with endometriosis is pain: pain with menstruation, pain with penetration and sometimes daily pain.
Endometriosis is a very common disease; it is estimated that around 10% of women of childbearing age suffer from it. But also in this case, the pain of penetration has a solution: we must go to the cause and treat the pathology that is causing that pain.
In any case, the general recommendation is that any woman who feels pain with penetration go to her medical professional to have her examined and find the cause and treat it.
Maribel Acien is Professor in Obstetrics and Gynecology, currently Associate Academic in Reproductive Health at University College London and Honorary Consultant in Gynecology at UCL Hospitals thanks to a Next Generation EU-UMH scholarship.
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