Four Skin Issues That Can Cause Vaginal Pain During Sexual Intercourse

There might be a medical reason for why sex is painful

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Quick Summary

  • 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.

 

1) Allergic Contact Dermatitis/ Irritant Dermatitis

Allergic contact dermatitis is a common cause of vaginal itching and can lead to pain during intercourse.[1] 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]

Allergens

Products

Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI)

Hygiene wipes, baby wipes, moist toilet paper

Fragrances

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

Nickel

Body jewelry

Corticosteroids

Topical medications (may be due to the vehicle, preparation or additives)

Latex

Condoms

 

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.[3] 

 

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).[5] It was reported that up to 75% of women may experience vaginal dryness.[6] and that an increase in symptoms occurs throughout the years after initial diagnosis of menopause.[5] Another cause of vaginal atrophy is due to breast cancer and breast cancer treatment.[7] 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.[8] 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.[6]

 

3) Scarring

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.[9] 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[9]

 

Lichen Sclerosus

Lichen Planus

Causes

Autoimmune vs Auto-inflammatory (?)

Autoimmune vs Auto-inflammatory (?) or Medication-caused

Age

Two peak onsets:

Prepubertal girls

Peri/Post-menopausal women.

Peri/Post-menopausal women

Other Associated Conditions

Autoimmune diseases

(thyroid, vitiligo)[10]

Autoimmune diseases (thyroid, vitiligo)[10]

Areas Affected

Prefers the genital area, rarely affects other tissues

Mucous membranes (vagina, eyes, esophagus, anus), skin, nails, scalp

Symptoms

Itching, degeneration of the skin, erosions, pallor, scarring. If lichen sclerosus is present for a long time, skin cancer can develop within the affected areas.

Pain, itching, burning, irritation, redness, erosions, bleeding. If lichen planus is present for a long time, skin cancer can develop within the affected areas.

Treatment

Corticosteroids

Corticosteroids, calcineurin inhibitors, emollients

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

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References

  1. Harper J, Zirwas M. Allergic contact dermatitis of the vagina and perineum: causes, incidence of, and differentiating factors. Clin Obstet Gynecol.2015;58(1):153-157; PMID: 25608257 Link to research.
  2. Bauer A, Rodiger C, Greif C, et al. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology.2005;210(2):143-149; PMID: 15724097 Link to research.
  3. Marfatia YS, Patel D, Menon DS, et al. Genital contact allergy: A diagnosis missed. Indian J Sex Transm Dis.2016;37(1):1-6; PMID: 27190404 Link to research.
  4. Erekson EA, Martin DK, Brousseau EC, et al. Over-the-counter treatments and perineal hygiene in postmenopausal women. Menopause.2014;21(3):281-285; PMID: 23880795 Link to research.
  5. Palma F, Xholli A, Cagnacci A, et al. The most bothersome symptom of vaginal atrophy: Evidence from the observational AGATA study. Maturitas.2018;108:18-23; PMID: 29290210 Link to research.
  6. Parnan Emamverdikhan A, Golmakani N, Tabassi SA, et al. A survey of the therapeutic effects of Vitamin E suppositories on vaginal atrophy in postmenopausal women. Iran J Nurs Midwifery Res.2016;21(5):475-481; PMID: 27904630 Link to research.
  7. Spronk I, Korevaar JC, Schellevis FG, et al. Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines. BMJ Open.2017;7(12):e015118; PMID: 29237652 Link to research.
  8. Gass ML, Taylor MB. Alternatives for women through menopause. Am J Obstet Gynecol.2001;185(2 Suppl):S47-56; PMID: 11521122 Link to research.
  9. McPherson T, Cooper S. Vulval lichen sclerosus and lichen planus. Dermatol Ther.2010;23(5):523-532; PMID: 20868406 Link to research.
  10. Cooper SM, Ali I, Baldo M, et al. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol.2008;144(11):1432-1435; PMID: 19015417 Link to research.