1.	First time intercourse - Painful intercourse with or without mild vaginal bleeding may be experienced during intercourse for the first time. It is not always a norm and the first sexual encounter may be pleasurable too.

2.	Long gap since the previous intercourse – In couples who have infrequent intercourse, it may be painful while having intercourse after a long time.

3.	Certain positions may be more painful due to direct thrusting of cervix. Changing the position will help.

4.	Inadequate foreplay prior to intercourse causes pain due to inadequate lubrication in the vagina. When the woman is aroused, the cervix moves backwards and upwards, reducing the discomfort from direct thrusting of penis and sex becomes pleasurable.

Pain during sex is called dyspareunia.
The gynaecological conditions causing painful 
intercourse include:

1.	Infections – Lower or Upper genital tract infections cause discomfort during intercourse. Appropriate diagnosis and treatment of these conditions provides adequate relief. Pelvic inflammatory disease is the infection of the upper genital tract which causes painful intercourse and affects fertility.

2.	Endometriosis – presence of endometrial tissue outside the endometrial cavity causes painful intercourse on deep thrusting of penis. This is a condition which affects the oocyte quality, embryo quality, fallopian tube patency, requiring repeated surgeries and affecting the ability of a woman to conceive.

3.	Tight or Rigid hymen – Hymen is the gatekeeper of the vagina. It normally has a gap in its centre and allows for easy passage of the penis through it. If it is too tight or rigid, the entry of the penis into the vagina gets painful.  It needs to be coorected by a simple Gynaecological procedure.

4.	Adhesions in pelvis due to infection of previous surgery. 

5.	Large uterine fibroids and Adenomyosis .

6.	Atrophic Vagina- there are certain conditions where vagina is not developed. It may be associated with non development of uterus too. Neovagina can be created for the purpose of intercourse and such women can bear children with assisted reproductive techniques.

Vaginismus is an intriguing condition where the woman develops a phobic response to vaginal insertion of penis, tampon or, medical instruments. Any kind of penetration is associated with tensing of the pelvic floor muscles and approximation of thighs. Sex becomes difficult to impossible in such women. Help is available for such conditions and it is necessary to consult a sexual health specialist or a Gynaecologist.
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