When sex hurts

A bit of doona action never hurt anyone, right?

A bit of a doona dancing usually feels great, right? So when it doesn't you need to pay attention. Your sex o'clock concerns are decoded here.

Feels like: pain and dryness
Could be: inadequate arousal. This is by far the most common cause of painful sex, which nearly two out of three women experience. Your body isn't designed to be penetrated until it's ready. Triggers include not enough foreplay, hormonal disorders, alcohol, depression, stress, certain drugs, and not feeling turned on by your partner.

Solutions: Some medications dry out your natural lubricant, or it could be a simple case of not enough foreplay. Always use lubricant if your natural lube is lacking.

Feels like: painful sex with discharge and itchiness; painful urination, sores or warts
Could be: an infection. That could mean an STI such as herpes, hlamydia or HPV, or an ailment such as a yeast or urinary tract infection (UTI). The symptoms may vary, and the friction caused by intercourse can intensify them, adding to your discomfort. Also, if you've started having sex again after a long drought, you may have contracted what is known as a "honeymoon UTI". It means having loads of intercourse without lubing up properly, setting you up for infection.

Solutions: certain infections, such as UTIs and thrush, can be easily treated with over-the-counter medications. But unless you've had one before and are sure of what it is, see your GP and get tested for STIs. Never ignore genital symptoms — most infections won't go away on their own.

Feels like: itchiness, redness, mild swelling, burning or stinging during sex
Could be: a skin irritation. The skin around the vagina is very sensitive, and many products can cause irritation. Some common culprits include fragrant soaps, laundry detergents, scented tampons and even edible lingerie. You could also be allergic to the latex in condoms and diaphragms. Narrow the field of suspects by keeping track of new products you've used or by eliminating possible causes one at a time.

Solutions: a cold compress — simply a clean face cloth soaked in cold water — can ease your discomfort. Creams containing one percent hydrocortisone can work well too, but don't ever use them on the inside of your vagina without first asking your GP. If it is an allergic reaction, oral antihistamines can help, but again, see your GP. As a general rule, try to avoid using any heavily scented or deodorised products around your genitals.

Feels like: pain on entry during sex; burning, sticking, tightness and muscle spasms in the vagina and/or lower back
Could be: Vaginismuses. The over-tightening of the vaginal muscles cause strong, involuntary muscle spasms (such as clamping shut) or intense pain during intercourse. It can be caused by trauma from birth or surgery; endometriosis (uterine tissue growing outside of the uterus); urinary tract infections; or triggers such as anxiety and stress of past emotional or sexual abuse. Remember when Sex and the City's Charlotte had a "depressed vagina"? Vaginismuses.

Solutions: certain exercises and relaxation techniques can stop the pain, including muscle-control exercises and insertion training that begins with a tampon or finger and leads to intercourse. Psychotherapy can work, but experts advise that physical and behavioural techniques can often work on their own.

Feels like: pain during sex, along with abdominal pain, discharge, fever, pain while urinating or irregular bleeding
Could be: Pelvic inflammatory disease (PID). PID is an infection of the upper genital tract that can be caused by an untreated STI, commonly Chlamydia or gonorrhoea. PID can lead to chronic pelvic pain and infertility so see your GP if you have any of the symptoms.

Solutions: it can be cured with antibiotics, but prompt treatment is crucial because antibiotics can't reverse the damage that may have occurred. The longer you wait, the higher your risk of infertility or an ectopic pregnancy (in which the embryo grows in the fallopian tube, not the uterus). About 10,000 women are treated for PID in hospital each year, and those aged 20 to 29 have the highest incidence of the disease.

Feels like: rawness, itching, stinging, or burning in the vagina or vulva
Could be: Vulvodynia. A US study revealed that around one in five women suffer from chronic pain in the vulval area at some point in their lives. The cause is not clear, but women with the condition may have a history of sexual abuse, vaginal infections, allergies or nerve injury in that region (most often from pregnancy).

Solutions: local anaesthetic ointments, warm baths and hormone creams have been shown to help some of the women who suffer from it. Some medications, including antihistamines and antidepressants (which may work to desensitise the nerves, rather than acting on a psychological cause), might also help mitigate the symptoms. Make sure you always ask your GP for guidance.