Womens Health

Pain and orgasm (cont'd)

First we need to know how the painful intercourse started. Did the pain start originally at the opening of the vagina (vulva, introitus), the inside of the vagina or only deep inside the pelvis when thrusting moves the pelvic contents such as the cervix, uterus or ovaries?

It should be easy for you to tell if the entrance to the vagina (introitus) was the original painful part. It would have hurt just with touching the area with your fingers or a pad rubbing against it.

Vaginal pain is a little harder to tell. The pain would be present mostly upon your partner entering the vagina and with the movement back and forth without deep penetration.

You probably have some degree of this pain now even though you may not have had it originally. This is because the vaginal muscles now involuntarily contract because of fear of being hurt and the contraction makes the vagina and opening smaller instead of larger which is the normal response.

Since you are on DepoProvera (R) which is known to cause vaginal dryness, this could have been or can still be your main problem.

Deep pelvic pain is much worse when you are having intercourse and you are on the "top" position. This results in the deepest penile penetration and often moves the pelvic organs.

Any pathology such as endometriosis, an ovarian cyst or uterine abnormalities can be painful with deep penetration. If that is your original pain problem then a pelvic exam and possibly a pelvic ultrasound will help clarify the cause.

Here are some of the possible causes of painful sex (dyspareunia)

Vulvar entrance

  • congenital abnormalities of the hymen
  • post traumatic scarring of the entrance
  • episiotomy scarring or delivery lacerations
  • post laser treatment of condyloma
  • vulvar hypersensitivity or allergic reactions
  • periorificial (irritant) dermatitis
  • cyclic/recurrent yeast vulvovaginitis
  • vulvar vestibulitis
  • dysesthetic vulvodynia
  • vulvar dermatoses


  • breast feeding
  • menopausal estrogen deficiency
  • use of DepoProvera (R)
  • use of progestin only birth control or
  • ovarian suppression

Lack of estrogen

  • vaginismus (involuntary pelvic muscle contraction)
  • vaginal foreign body


  • endometriosis
  • adenomyosis
  • interstitial cystitis of bladder
  • ovarian neoplasm
  • ovary adhered to uterus/vaginal apex
  • prolapse of fallopian tube
  • pelvic adhesions
  • uterine prolapse/descensus
  • uterine retroversion
  • posterior uterine fibroid
  • other uterine neoplasms

As you can see the list of possibilities is extensive and treatment must be directed toward the initial cause. Once the initial cause of pain has been treated, any secondary vaginismus (vaginal or pelvic muscle spasm) due to a learned fear of pain must be treated.

This is a slow process and will involve your partner's help in getting the pelvic muscles to relax rather than contract. You will need you doctor's help or that of a professional sex therapist for instructions on manual massage of the vaginal muscles to induce relaxation.

Related Educational Articles

Polycystic Ovarian Syndrome and Pelvic Pain
Adenomyosis - An Internal Uterine Endometriosis
Relationship of Hysterectomy to Chronic Fatigue and Fibromyalgia Syndromes
Abdominal or Pelvic Pain Occurring Monthly
Hysterectomy for Endometriosis in Young Women
Post Tubal Ligation Syndrome Review
Muscle Pain Presenting as Pelvic Pain
Painful Sex and Vulvar Skin Disease
Does Endometriosis Always Cause Pain?
Laparoscopically assisted vaginal hysterectomy
Interstitial Cystitis - Pelvic Pain from the Bladder
Painful Intercourse Due to Vulvar Vestibulitis
Ultrasound Diagnosis of Endometriosis


Table of Contents
1. Pelvic Pain Overview
2. Left sided pelvic pain
3. Upper quadrant pain
4. Abdominal bloating
5. Adenomyosis
6. Ovulatory pain
7. Bicornuate uterus
8. Pain after a c-section
9. Pain and orgasm
10. Causes of painful sex
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