When You Experience Pain During Sex

By Susan E. Sklar, M.D.
Nationally, 43% of women[1] suffer from some sort of sexual function problem and three out of four women[2] will experience pain during sex. In many cases, painful sex lasts only for a brief period and clears up relatively quickly. Unfortunately, for some women, painful sex lingers long-term, complicating your relationships and making you wonder about your personal health. If you’ve experienced pain during sex, you aren’t alone. Knowing how to deal with it can help you move forward with your life and your relationship.
Consider, for example, Betty a woman in her late 40’s. Betty has started the transition into menopause, and she decided to take the natural route. At first, it worked out well for her. She was naturally making the transition as she aged and enjoyed sex as usual. Eventually, however, Betty had to start using a lubricant jelly for sex due to vaginal irritation. She was starting to feel dry and less comfortable during sex. So, adding a lubricant seemed like a reasonable solution.

Eventually, that stopped working too. Indeed, sex became even more painful. It felt like there was sandpaper rubbing against her skin. She quickly began to wonder if she would ever be able to have enjoyable sex again.

Many women have similar problems. For the first year, or maybe even two, after their last period, they think things are going all right. Vaginal tissues are still somewhat healthy during this period. Then, the tissues start to thin and lose elasticity. You no longer have estrogen on board, which means that your body isn’t responding the way it did in younger years. We see many women like this at the Sklar Center on a regular basis. Here’s the good news: it’s totally reversible, and you don’t have to face it alone.

What Is Painful Sex?

Pain that occurs during intercourse can be incredibly frustrating and limiting. It may occur at the vaginal opening or within the pelvis. It may be clearly localized, with what appears to be an obvious source, or you may notice a broader sense of discomfort that seems difficult to pin down. Women may complain of many different types of pain sensations, including aching, burning, ripping, or throbbing sensations, depending on the condition that causes these complications. Further, many women observe dissatisfaction with intercourse or lose their interest in sex due to ongoing pain.

Types of Painful Sex

Pain during sex can occur in a number of locations:

  • Entry pain at the vaginal opening or at the perineum (the area between vagina and anus)
  • Deep pelvic pain, felt deep in the lower abdomen, bladder area, or low back

Each type of pain has its own causes. You should be able to have enjoyable sex without pain. If you have painful sex, be sure to seek medical care from an expert in women’s health so you can discover the cause and fix it.

Seeking Help for Pain During Sex

If you’re suffering from pain during sex, scheduling an appointment with your doctor can help you address the problem and, in many cases, get back to feeling more like yourself again. Many women, however, hold off on making that appointment because they have no idea what to expect–or perhaps because they’re uncomfortable with the entire discussion. At your appointment, you can expect your doctor to:

Take a Full Medical and Sexual History Report

In many cases, either your medical history or your sexual history can help reveal the cause of pain during sex. Do not leave anything out as you talk to your doctor: pregnancy and childbirth, including complications; miscarriages and abortions; your sexual history (even those embarrassing parts from back in college). You should also mention any medications or supplements you take on a regular basis and any other medical conditions you suffer from, since all of them could impact your sexual health and what pain you experience. A full picture of your overall health and history can help your doctor better establish what is causing painful sex.

Conduct a Physical Exam

Your doctor will examine you for any visible causes of painful sex. You can expect both an external and internal exam.

Conduct Tests, If Needed

Tests may include ultrasounds, pelvic exams, a visit to a dermatologist to rule out any skin conditions or problems, or visits with other specialists.

As your doctor walks with you through testing and evaluation, keep in mind that these tests are for your benefit. In many cases, painful sex is completely fixable–but you have to start with a practitioner who is knowledgeable about the types of problems that can cause painful sex. At Sklar Center, we receive extensive training in women’s sexual health issues. This helps position us to more effectively help women address their concerns and find the cause — and treatment for — painful sex.

Barriers to Discussing Painful Sex

An open discussion with an experienced physician who understands women’s health issues and will stand as your advocate is the most effective way to address painful sex. Unfortunately, many women struggling with painful sex and other reproductive health concerns continue to suffer in silence due to embarrassment and a continuing lack of desire to discuss the situation.

In a “Women’s Voices in Menopause”[3] survey, completed by 4246 women between the ages of 55 and 65, women in Canada, Finland, Sweden, the United Kingdom, and the United States all had the opportunity to answer questions about their sexual and reproductive health. It revealed several unsettling facts:

  • 30% of women worldwide and 33% of women in the United States who experienced vaginal dryness didn’t talk about it with anyone.
  • Only 30% of women worldwide and 34% of women in the United States with vaginal discomfort talked to their gynecologist.
  • Only 29% of women worldwide–and just 22% in the United States–talked to their general practitioner about vaginal discomfort, including dryness, pain with touching or intercourse, or involuntary urination.

Why don’t women want to talk about painful sex? For several key reasons. 60% of women in the United States admitted, “It makes me uncomfortable or embarrassed.” 52% of women add, “I do not think other people want to hear about my vaginal problems. It is private and does not concern others.” Further, 49% of respondents say,  “It’s just part of growing older.”

Unfortunately, this continuing lack of discussion means that many women aren’t able to address problems when they arise–and the lack of willingness and embarrassment to discuss these problems even with their doctors can leave women without the solutions they so desperately need.

Conditions That Can Cause Painful Sex

Many types of conditions can cause issues that lead to painful sex. Life with these conditions or concerns, however, does not necessarily mean that you have to live with painful sex. In many cases, an experienced physician can help you find a solution.

Entry Pain

Common Gynecologic Conditions
Many familiar conditions, including pelvic inflammatory disease, endometriosis, or adhesions can all cause painful sex. A doctor can give you a better idea of how to address those symptoms and, in many cases, alleviate that pain.

Vaginal Dryness
A lack of proper lubrication, including dryness due to a lack of foreplay, can cause substantial pain during intercourse.

Vulvodynia, or Chronic Vulvar Pain
Over the course of a lifetime, 16% of women[4] will experience vulvodynia, or pain in the vulva. In some cases, generalized pain occurs with seemingly no reason. In other cases, women may experience pain due to stimulus, including sexual activities or tampon insertion.

Common Skin Disorders
If you have a skin disorder that impacts other areas of your skin, it can cause problems in your genital region, as well. If you struggle with contact dermatitis, for example, you may struggle with itching, burning, or pain when exposed to triggers you’re allergic to, including perfumed soaps or some types of lubricants.

Hormonal Changes
During perimenopause and menopause, many women go through significant hormonal changes that can also lead to painful sex. During menopause, many women experience thinning of the linings of the uterus, which may ultimately lead to painful sex. Vaginal dryness also becomes more common during perimenopause or after menopause.

Birth Control
Use of hormonal birth control can cause thinning in the lining of the uterus. Like menopause, it can also lead to symptoms of vaginal dryness, which may increase the odds of painful sex.

Pregnancy
Women experience many hormonal changes during pregnancy. In many cases, increased vaginal dryness or other pregnancy-related discomforts can add to pain during intercourse.

Childbirth
During the birthing process, some women suffer tears in the perineum or need an episiotomy to allow them to deliver the baby safely. This can lead to tenderness and pain during intercourse for weeks or months after the child is born.

Vaginitis
Vaginal inflammation often appears first as discharge and itching and burning. It may increase to ongoing pain during intercourse.

Vaginismus
Some women suffer a painful tightening of the muscles at the opening of the vagina when they attempt to engage in intercourse. This tightening occurs due to reflex, rather than a conscious choice.

Deep Pain

Many medical conditions[5] and treatments can lead to deeper pain during sex, including:

  • Endometriosis
  • Hysterectomy
  • Pelvic floor surgery
  • Some cancer treatments
  • Cystitis
  • Fybroids
  • IBS
  • Pelvic inflammatory disease
  • Uterine prolapse
  • Ovarian cysts

Most of these medical conditions must be addressed by a medical professional in order to help you get the relief you need to enjoy sex again.

Psychological Causes

Some psychological concerns can contribute to painful sex. If you find that you have some of these symptoms, working closely with a women’s health specialist or a psychologist who specializes in sexual health can help you work through these concerns.

  • Anxiety
  • Depression
  • A history of sexual assault or abuse
  • Fear
  • Stress

Help Is on the Way for Painful Sex

While you’re waiting to see your doctor, there are several things that you can do on your own to help deal with painful sex. By utilizing a few strategies, you can often reduce or even eliminate painful sex. Your doctor can help recommend even more treatment options that will help reduce or even eliminate pain altogether.

Using Lubricants
One of the most effective ways to relieve pain due to vaginal dryness is the use of a lubricant. You should use a water-based lubricant to help reduce the risk of yeast infection. A silicone-based lubricant can also be highly effective. Apply generously, and don’t be afraid to reapply if needed throughout.

Talk With Your Partner
If you’re struggling with pain during sex, communication with your partner is critical. Communication can help your partner focus on the parts of sex you still find pleasurable and avoid the things that hurt during sex.

Set Aside Specific Time for Sex
Instead of trying to have sex in a hurry, when you’re tired, or when you have to be somewhere else in a very short period of time, set aside more time for sex. Take things slowly, instead of rushing. You may find that simply taking more time can make a big difference in the pain you experience.

Try Different Sexual Activities to Find One That Does Not Cause Pain
Your sexual relationship with your partner doesn’t have to suffer because of painful sex. Instead, try engaging in oral sex or manual stimulation. You might find that some types of sexual stimulation bring more pleasure and enjoyment than others–and while you address the physical problems associated with sex, you and your partner can focus on those aspects of sex.

Enjoy Sensual Activities, Not Just Sex
Engage in a massage. Take a warm bath or shower with your partner. These simple activities can help you relax and, in some cases, make sex more pleasant.

Use a Few Pain-Relieving Steps to Make Sex More Comfortable
Try taking an over the counter pain reliever before sex or apply ice or a frozen gel pack wrapped in a washcloth or towel to your vulva to help relieve burning after sex.

Medical Help for Painful Sex

When at-home remedies aren’t working, turning to a specialist in women’s medicine can make it easier to address many of the symptoms of painful sex.

Estrogen Cream

The best relief for painful sex due to thinning of the vaginal linings is estrogen cream.  Estrogen cream[6] can help reverse thinning, dryness, and pain associated with hormonal changes, including menopause. While it may take two to three months for it to take full effect, this method can, over time, create a marked decrease in painful sex by addressing the underlying cause. A recent study[7] showed that a small amount of estrogen cream placed at the vaginal opening twice a week for 12 weeks resulted in markedly reduced vaginal dryness, itching, burning, and pain.  Indeed, this is what gave Betty relief of her painful sex.  After 3 months of using just a small amount of estrogen cream around her vaginal opening, she had more lubrication.  Her pain was gone and she went back to enjoying sex again.

Laser Therapy

The benefit of laser therapy for vaginal thinning and vulvodynia has not yet been proven, but some people do believe they can use this method to reduce their symptoms.

Estrogen Modulators

A new medication called Osphena or ospemifene can help reduce some symptoms of painful intercourse. This medication, however, can cause significant side effects[8], which make many women feel as though it isn’t worth it.

Find More Tips for When You Experience Pain During Sex

If you have questions or problems with sexual function, early symptoms of menopause or menopause, you’ve come to the right place. Dr. Sklar is an expert in helping you reach sexual health. She has been actively involved in national and international sexual health organizations. The Sklar Center will get to the root of your problems, balance your hormones, and guide you to fulfilling and satisfying sexual health.

If you would like more information or are considering a personal evaluation at the Sklar Center, give us a call today at 562-596-5196 to request a free consultation.

References

  1. Edward O. Laumann, PhD; Anthony Paik, MA; Raymond C. Rosen, PhD
    Sexual Dysfunction in the United States – Prevalence and Predictors
    JAMA. 1999;281(6):537-544. doi:10.1001/jama.281.6.537.
    LINK: Sexual Dysfunction in the United States – Prevalence and Predictors
  2. American College of Obstetricians and Gynecologists
    When Sex Is Painful
    ACOG Women’s Health Care Physicians. FAQ020, September 2017.
    LINK: When Sex Is Painful
  3. Nappi RE, Kokot-Kierepa M.
    Women’s voices in the menopause: results from an international survey on vaginal atrophy
    NCBI. 2010 Nov;67(3):233-8. doi: 10.1016/j.maturitas.2010.08.001. Epub 2010 Sep 9.
    LINK: Women’s voices in the menopause: results from an international survey on vaginal atrophy
  4. Christina Damsted-Petersen, Stéphanie C Boyer, Caroline F Pukall
    Current Perspectives in Vulvodynia
    Women’s Health. Volume: 5 issue: 4, page(s): 423-436.
    LINK: Current Perspectives in Vulvodynia
  5. Jayne Leonard
    What causes dyspareunia, or painful intercourse?
    MedicalNewsToday. Medically reviewed by University of Illinois-Chicago, School of Medicine on December 22, 2017.
    LINK: What causes dyspareunia, or painful intercourse?
  6. Krychman ML
    Vaginal estrogens for the treatment of dyspareunia.
    J Sex Med. 2011 Mar;8(3):666-74. doi: 10.1111/j.1743-6109.2010.02114.x. Epub 2010 Nov 22.
    LINK: Vaginal estrogens for the treatment of dyspareunia.
  7. Maitri Shah, Zalak Karena1, Sangita V. Patel, Niyati Parmar, Pawan K. Singh and Atul Sharma
    Treatment of Vaginal Atrophy with Vaginal Estrogen Cream in Menopausal Indian Women
    Oman Med J. 2017 Jan; 32(1): 15–19.
    LINK: Treatment of Vaginal Atrophy with Vaginal Estrogen Cream in Menopausal Indian Women
  8. Lin H Soe, Gregory T Wurz, Chiao-Jung Kao, and Michael W DeGregorio
    Ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy: potential benefits in bone and breast
    Int J Womens Health. Published online 2013 Sep 25. doi: 10.2147/IJWH.S39146.
    LINK: Ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy: potential benefits in bone and breast

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