Have you heard of Dyspareunia? It’s more commonly referred to as painful sex. Seven Oaks Women’s Center wants to take the stigma out of the condition and help women get back to enjoy a healthier sex life. It is more common than you think. At some point in their lives, 3 out of 4 women will experience episodes of painful sex.
Almost everyone finds it difficult to talk about with their friends, and maybe even their doctors. Whether you have experienced chronic dyspareunia and have gone from one doctor to another, or are simply uncomfortable talking about intercourse, it can be a difficult discussion to have. Many women are afraid the answer will be that there are no options to help them feel better.
Sex is not supposed to hurt unless you want it to. Some women think it is “normal for them” to not be able to enjoy sex because of pain. Minor soreness or tingling/burning after particularly rough or fast, intense sex can be normal. However, recurrent, undesired pain in the vulva, vagina, or pelvis is not normal.
There are many conditions, some more common during specific phases of life, that can lead to painful sex.
- Infection. One of the most important things to evaluate first is to rule out sexually transmitted diseases, a yeast infection, or other bacteria that can cause painful sex. This can be done during a pelvic exam in the office, and by vaginal or vulvar cultures.
- Hormonal changes. As many as 50% of menopausal women will experience painful sex as a result of low hormone levels, particularly estrogen levels. Estrogen begins to decline in the years prior to menopause, or perimenopause. Estrogen is a hormone that has receptors all over womens’ bodies, but when it is low, the specific vaginal effects can be painful sex, having irritable vaginal tissue that bleeds easily after sex, vaginal dryness or irritation outside intercourse, and difficulty lubricating. Women who are breastfeeding and women who are on certain medications that decrease estrogen levels (treating certain cancers) may also experience painful sex as a result of low estrogen. There are several options for replacing vaginal estrogen, including oral pills available now. Also, replacing other hormones, such as testosterone or prasterone, can be treatment options.
- Skin disorders. The vulva and vagina can develop a chronic reaction to something that is contacting the area, even if this is a product that has been used for several years, including latex condoms. This can cause chronic irritation and pain. It is important to never clean inside the vagina, and use only hypoallergenic soaps and cleansers to the vulvar area – these have no dyes and no fragrances. There are other skin conditions that can affect the vulva such as psoriasis or lichen sclerosis. These can be diagnosed during an exam, and sometimes require a biopsy of the affected area.
- Vaginismus. This is a contraction, tightening, or closing of the vaginal muscles that is out of a woman’s control. This can cause pain during penetration and during intercourse. There are options to treat this condition, such as pelvic floor therapy.
- Vulvodynia. This is chronic pain at the vaginal opening. This can cause soreness, burning, stinging, irritation, rawness even outside of intercourse.
- Scar tissue after having a baby. It takes time for the vagina and perineum to heal, but if pain is persistent, it is worth talking about the discomfort.
- Endometriosis. This is a chronic condition that can also cause heavy and painful periods. Endometriosis can cause pelvic pain with deep penetration. This is usually a more complicated discussion, but treatment options can include hormonal treatments, and at times laparoscopic surgery.
- Ovarian cysts. Also cysts typically cause pain with deeper penetration, but may also cause pain outside sex. This would be important to evaluate with an ultrasound.
So many things can affect our sexual response to make sex uncomfortable. For women, we know sex is not as easy as flipping an “on-switch” most of the time. If there is a long “to-do” list, if there was an argument with your partner, if stress, guilt, fear, or shame are feelings at the time, these can affect the body’s ability to relax, be aroused, and enjoy sex as well. Mental health can be a significant contributor.
Also somewhat unfair, some antidepressant medications, medications for birth control, blood pressure medications, allergy medications – all of which we use to take better care of ourselves – can potentially decrease natural lubrication and translate into painful sex. If a male partner is having difficulty maintaining an erection, this can lead to longer, and at times painful intercourse.
Things you can try before talking to a gynecologist
- Try lubrication. Coconut and olive oil are easily available products that are safe and hypoallergenic, but not compatible with condoms. With condoms, use a silicone-based lubricant as water-based lubricants may dry out more quickly and can cause more friction.
- Talk with your partner and be open about the issues. Be specific about when and where the pain is, specific positions that may be more painful, and what is more enjoyable for you. Try activities such as mutual masturbation or oral sex if they are less painful. Make adequate time for sex when both partners are not anxious or tired so that it does not have to feel rushed. Easier said than done when children are at home!
- Use an ice or frozen gel pack wrapped in a soft towel for mild vulvar discomfort after intercourse, or can try a warm bath.
Dealing with chronic pain during sex can seem hopeless and frustrating, but the best thing to do if you are concerned is to talk to a gynecologist, and all of us at Seven Oaks would love to start the conversation with you!