To be able to make love without pain, there must be sufficient
desire to make love and sufficient arousal. The woman must have relaxed
pelvic floor muscles and there shouldn't be any irritated body parts e.g a
bladder infection, venereal diseases, insufficient lubrication of the
vagina, oedema, a tight foreskin etc.
It is important to look at the problem from different points of view.
There may be a biological cause. This may be a sexually transmitted
disease, a vaginal infection, a disorder of the uterus or the large
intestine, an infection of the vaginal mucous membrane, a snip or a tear
during childbirth and insufficient lubrication of the vagina. Men may
have infections on skin anomalies to the penis, infections of the glans
and the foreskin due to fungi or bacteria, a tight foreskin, prostatitis,
or a low testosterone level (hormones). In women, vestibulit (an inflammation in the vagina) can be a cause of sex pain.
A medical investigation is an important step in the treatment process.
The pain may be due to social causes like relational problems.
Communication problems between the partners may play a role. Many people
are afraid to indicate what they like in the sexual field. Psychological
causes may also play a role. Since many women can't relax sufficiently,
the vagina doesn't get wet enough the penis rubs against the side of the
vagina, which leads to irritation. Due to the fear of pain the pelvic
floor muscles are tensed too much, which causes the love play to hurt.
The woman gets into a vicious circle of fear of pain, which leads to
tension, the tension to extra pain and no more arousal, which leads to a
dry vagina, which leads to more irritation, etc. There may also be
negative thoughts and feelings about sexuality and certain harmful events
may play a role.
Vestibulitus and vaginismus are other possible causes of pain during sex.
For men who can masturbate without pain, physical causes may often be
excluded. Fear of pain may lead to the avoidance of the pain by not
wanting to make love anymore.