Sex can be painful as a result of skin diseases that affect the vagina and vulva
Four skin diseases that can make sex painful include contact dermatitis, skin thinning, scarring, lichen planus, and lichen sclerosus
If sex is painful, seek help from a doctor and dermatologist
Vaginal pain during intercourse can be uncomfortable and worrisome to both you and your partner. Sexually transmitted infections (STI) or vaginal infections are commonly known for causing vaginal pain, however, there are skin conditions less frequently discussed that can cause these symptoms.
Allergic contact dermatitis (ACD) is a common cause of vaginal itching and can lead to pain during intercourse. ACD is triggered by a chemical in products (also known as allergens) used for the skin. When a hypersensitive individual comes in contact with the chemical it creates an immune response from the body, often times leading to itching and redness. The most common causes of ACD in the vaginal area are listed below along with products that contain them.
Table 1. Chemicals That Cause Vaginal Allergic Reactions[1-4]
Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI)
Hygiene wipes, baby wipes, moist toilet paper
Balsam of Peru
Feminine hygiene products (cleanser, sanitary napkins, tampons, body lotion, deodorants, and antiperspirants)
Anesthetics (dibucaine HCl, benzocaine, lidocaine, and tetracaine)
Local anesthetic creams (may be commonly used in laser hair removal/waxing), spermicides
Topical medications (may be due to the vehicle, preparation or additives)
Discontinuing the products that cause the discomfort is strongly advised. If the allergen is not discontinued, inflammatory factors will be released and lead to a decrease in the activity of the local immune function. This can predispose to a possible yeast infection.
2) Vaginal Atrophy (Thinning)
Vaginal atrophy is the thinning, drying, and inflammation of the vagina due to a decrease in estrogen production. Estrogen is important for preserving the collagen content of the skin and maintaining its thickness. A decrease in estrogen leads to several complications during menopause and has a high negative impact on female quality of life. According to studies, amongst all postmenopausal women, vaginal dryness is the most bothersome symptom that commonly leads to dyspareunia (painful sexual intercourse). It was reported that up to 75% of women may experience vaginal dryness. and that an increase in symptoms occurs throughout the years after initial diagnosis of menopause. Another cause of vaginal atrophy is due to breast cancer and breast cancer treatment. This includes hormone therapy, chemotherapy, and radiotherapy.
Therapy for vaginal atrophy includes topical estrogen and systemic estrogen replacement, although there is more reluctance with systemic estrogen replacement due to the possible complications. The use of vitamin E alone or in conjunction with other therapies has been reported to be successful in vaginal atrophy. In fact, suppository vitamin E is recommended for women who are poor candidates for hormonal therapy.
Vaginal scar tissue can develop after vaginal birth, vaginal surgery (episiotomy), body piercing, or chronic irritation. Scarring happens as a result of the healing process. Friction and irritation of the scarred tissue can lead to pain during intercourse and can take some time to resolve.
4) Lichen Planus and Lichen Sclerosus
Lichen sclerosus and lichen planus are inflammatory skin conditions and may result from the immune system attacking the self. There are notable differences between the two conditions, which have been listed below. Both skin conditions cause discomfort in the vaginal area and complain of itching, tenderness, pain, and stinging sensation, ultimately making intercourse uncomfortable.
Table 2. Lichen Sclerosus and Lichen Planus
Autoimmune vs Auto-inflammatory (?)
Autoimmune vs Auto-inflammatory (?) or Medication-caused
Two peak onsets:
Other Associated Conditions
Autoimmune diseases (thyroid, vitiligo)
Prefers the genital area, rarely affects other tissues
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