Painful sex
Pain with penetration
Pain inserting anything eg Tampons
Burning pain, dull pain
Bleeding with intercourse-slight/heavy/much/little
Pain in abdomen with deeper penetration
Sudden onset/gradual onset
Obvious trigger eg after an event or no obvious trigger (commonly the case)
Psychological background or no psychological background
Causing relationship issues/avoidance of sex
Hindering conception
Premature ejaculation
Painful skin-pulls/tears/bleeds
painful testicles
increased unpleasant sensitivity
Seek help
If the GP is not able to help or may not see anything wrong. Ask for a referral to a specialist
Women: see www.vulvalpainsociety.org website. Can be very helpful
Vestibulodynia and Vulvodynia both are pain syndromes. There are specific places where the pain
arises but the appearance may be totally normal may be associated with other painful conditions eg facial pain, migraine, fibromyalgia
In some women, it is associated with conditions such as hay fever, urticaria, skin sensitivity often associated with vaginismus where the vaginal muscles become very tense. Each condition then aggravates the other, sex becomes more painful and sometimes impossible or certainly seems better avoided
Pelvic problem eg endometriosis, pelvic infection
Vaginal infection eg candida, bacterial vaginosis
Genital Skin problem
Skin infection -Herpes, Candida for example
Examination using a cotton bud to test sensitivity
Skin examination
Vaginal examination taking a swab to examine under a microscope and sometimes swabs for infection including chlamydia
Pelvic examination
Possibly pelvic ultrasound
Depending on findings may need treatment for infection usually with antibiotics, treatment for candida topically or orally
Vestibulodynia is treated with local anaesthetic gel or ointment applied very specifically to the area of tenderness. Sometimes also antihistamine and occasionally pain modifying tablet such as Amitryptiline
Pelvic physiotherapy is often very helpful for vaginismus
An examination may reveal an area of the skin causing pain
Maybe urethral infection-usually a urine test helps the diagnosis
Testicles may be sensitive eg due to inflammation commonly in the epididymis, the tube alongside the testicle
Depending on examination and tests. Possibly antibiotics, possibly creams, occasionally a local anaesthetic
Dr Pritchard