Doc Talk: Why Does It Hurt When I Have Sex
Experiencing pain during sex can seem like a normal occurrence, with nearly 3 out of 4 women saying they have had pain during sex at some point in their lives, according to The American Congress of Obstetricians and Gynecologists . For some women, the pain may only be mild soreness, but for others, the pain can be deep and chronic. Recurring pain during sex is called dyspareunia, it is a medical condition where there is pain or discomfort in a womanâs labial, vaginal, or pelvic areas during or immediately following sex.
While you may be reluctant to share your sexual experiences with your Womens Health Connecticut provider, it is important to speak honestly and openly with your ObGyn if sex is more painful than pleasurable. We spoke with two providers at Womens Health Connecticut Dr. Elisa Benzoni of Specialists in Womens Healthcare and Dr. Gayle Harris of Connecticut Women OB/GYN, to discuss the main causes of painful sex and treatments that can help women experiencing dyspareunia.
What are the causes of painful sex?
Dr. Harris: Common causes include menopause, infections, a history of sexual abuse or assault and musculoskeletal and neurologic conditions.
How can patients address sexual abuse with their doctors and how would you advise them to ease any symptoms they may have?
What is vaginismus and can it cause painful sex?
Painful Sex: Vaginitis and Vulvodynia
What is Vaginitis and how does it cause painful sex?
What is vulvodynia and how can it cause painful sex?
Ovulation Pain Or Midcycle Spotting
Mittelschmerz is a German word that translates as “middle pain.” It refers to the normal discomfort sometimes felt by women during ovulation, which is at the midpoint of the menstrual cycle.
Each month, one of the two ovaries forms a follicle that holds an egg cell. The pain occurs when the follicle ruptures and releases the egg.
This is a dull, cramping sensation that may begin suddenly in only one side of the lower abdomen. In a few cases, there may be vaginal spotting. Mittelschmerz occurs about 14 days before the start of the next menstrual period.
Actual Mittelschmerz is not associated with nausea, vomiting, fever, or severe pelvic pain. These symptoms should be evaluated by a medical provider since they can indicate a more serious condition.
Diagnosis is made through patient history.
Treatment requires only over-the-counter, nonsteroidal anti-inflammatory drugs to relieve the pain. An oral contraceptive will stop the symptoms, since it also stops ovulation.
Top Symptoms: abdominal pain , last period approximately 2 weeks ago, vaginal bleeding, bloody vaginal discharge, pelvis pain
Symptoms that always occur with ovulation pain or midcycle spotting: last period approximately 2 weeks ago
How Long Does It Take To Recover From Dyspareunia
The recovery time for dyspareunia varies depending on the underlying cause for the pain you feel during sex. The good news is that you can find relief and recover from painful sex. Whether it is medication, counseling, surgery or using lubricationyour healthcare provider can find a treatment that can improve or eliminate dyspareunia.
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How To Relieve Painful Sex After Menopause: Monalisa Touch
You have many options for relieving painful sex, including lubricants, moisturizers, hormone therapy, and more. But the providers at Suncoast Womens Care truly believe in the power of one special treatment: MonaLisa Touch.
MonaLisa Touch is a gentle, noninvasive treatment that can improve vaginal symptoms after menopause, including pain, laxity, and dryness. The fractional CO2 laser delivers energy to your vaginal tissue, stimulating your bodys natural healing processes. The laser energy also helps your body produce new cells and increase the production of collagen and elastin, two important components of healthy vaginal tissue.
The procedure is quick, with most sessions taking no longer than five minutes. You also wont endure any downtime, so you can return to your normal daily activities as soon as youre through. You should, however, abstain from sex for a day or two after your treatment. Some patients experience minor sensitivity or swelling after MonaLisa Touch and prefer to wait until it subsides. \You may notice improvements after just one session, but most patients return for a few sessions, each spaced out by about six weeks.
Its Best Not To Ignore Any Changes That Cause You Distress
You may cringe at the thought of talking to your gynecologist about sex. But rest assured, there is no reason to feel awkward. If you’re dealing with these changes and are very much unhappy with them, talk to your doctor. Right now, this may be a conversation that needs to take place via telehealth due to the pandemic. If you feel dismissed, then Dr. Rowen encourages you to consider switching to another provider if at all possible. Go find someone who will listen to you and take your problems seriously, Dr. Rowen says. Together, you can come up with a treatment plan that may help you have a more fulfilling sex life, even after menopause.
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Your Libido Might Dip Thanks To Menopause
Its not universal, but some people with menopause report decreased libido, says Dr. Pizarro. Issue is, it’s tough for doctors to figure out how to combat a lowered sex drivethe cause isnt exactly easy to pinpoint. For decades, weve blamed loss of libido on a womans ovaries or hormones, says Libido is such a complicated thing that goes way beyond issues of the ovaries, uterus, and hormones, says Dr. Pizarro.
Beyond whatever mysterious physiological changes might affect someones libido at this life stage, adjusting to menopause’s physical changes might play a role. Adequate exercise helps make sure your blood is flowing properly, which is an essential part of getting wet during sex.
Why Am I Still Spotting After My Period Ends
Continuous bleeding after a period can be caused by a many things. Most commonly, an abnormally long period may have no discernible cause. If it does not recur, it may require no further investigation. Continuous spotting may be a sign of a disorder in coagulation caused by either medication or a genetic disorder. It may also be a sign of infection of the vagina or cervix.
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How Sex Changes After Menopause
Chris Kraft, Ph.D.
With no need to worry about getting your period, becoming pregnant or being walked in on by your kids, your postmenopausal sex life should be stellar, right? It can be good, but dont expect it to be the same type of sex you were having in your 20s, says Chris Kraft, Ph.D., director of clinical services at the Sex and Gender Clinic in the department of psychiatry at Johns Hopkins Medicine.
While you may have greater freedom at home, this is also a stage of life with a lot of changes that can affect your intimacy, he says. Youre redefining your roles and your relationship as the kids go off to college and your careers wind down. And youre also physically changing.
Communicate With Your Partner
For many women, experiencing painful intercourse comes with feelings of inadequacy and shame.
Its important to remember that you are not alone. Thousands of women across the globe struggle with painful sex and thousands have effectively treated their symptoms and recovered.
While effective and open communication is important in any relationship, its even more so in a relationship affected by sexual dysfunction. Keep those lines of communication open, and talk about what youre experiencing and feeling with your partner it will only serve to make the situation easier for both of you.
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Other Conditions That Cause Pain
Pain during sex isnt always due to atrophy. It could also be a sign of these conditions:
Vestibulodynia. The vestibule is the area where the vulva the outer parts of the vagina including the clitoris, clitoral hood, and labia connects with the vagina. In some women, the vestibule becomes very sensitive to touch. Having sex or inserting a tampon is very painful. Doctors can treat this condition with local anesthetic creams or gels, physical therapy, and mental health counseling.
Vulvodynia. This condition causes pain or burning in the vulva without any obvious cause. About 60 percent of women with vulvodynia are unable to have sex because of the pain. Treatments include topical anesthetics, physical therapy, and mental health counseling.
Vaginismus. In this condition, the muscles around the vagina contract painfully during sex, or whenever something is inserted into the vagina. It may be triggered by fear after a traumatic experience. Treatments include a dilator to widen and relax the vagina and physical therapy.
Cystitis. Bladder inflammation can cause pain during sex because the bladder sits right on top of the vagina. At least 90 percent of people interviewed by the International Cystitis Association said interstitial cystitis negatively affected their sex life. Treatments for cystitis include medication, nerve blocks, and physical therapy. Relaxation techniques, heat, or cold may also help relieve discomfort.
Why Am I Experiencing Vaginal Bleeding After Menopause
Vaginal bleeding after menopause may be due to medications, hyperplasia of the uterus, or some types of uterine cancer. Certain medications containing estrogen or progesterone can cause either hyperplasia or an increase in the amount of tissue in the uterus, which may cause bleeding or an excess sloughing off of tissue both of which will be seen as vaginal bleeding.
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Treatment Solutions For Sexual Discomfort
Finding the right solution for sex-related pain depends on its underlying cause. If that cause isnt readily apparent, a more exhaustive investigation can often reveal the reason for persistent discomfort.
In addition to performing a comprehensive physical exam, including a pelvic exam, we ask about your medical history to find out if you have any conditions or take any medications that may obstruct your normal sexual response. We also ask about your sexual history, to find out if any events in your past affect how you feel about sex.
Effective treatment for one woman may simply mean changing a prescription medication that interferes with natural lubrication, while a woman whos living with the aftereffects of an episiotomy or perineum tear from a recent childbirth may get the best results from physical therapy or surgery.
Hormone replacement therapy , or the supplementation of reproductive hormones that your body no longer makes, has long been the go-to treatment option for menopausal women affected by vaginal dryness and sexual pain.
Although HRT in the form of low-dose topical vaginal estrogen can be highly effective for some women, its a short-term solution that isnt medically appropriate for all women.
How Is Dyspareunia Treated
Some treatments for sexual pain do not require medical intervention. For example, in the case of painful intercourse after pregnancy, wait at least six weeks after childbirth before attempting intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.
Some treatments for sexual pain do require prescription medication. If vaginal dryness is due to menopause, ask your healthcare provider about estrogen creams, tablets, rings or other medications. Other causes of painful intercourse also may require prescription medications.
For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve guilt, inner conflicts regarding sex or feelings regarding past abuse.
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Having Sex Is Becoming Painful: What Can I Do
Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a womans quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity.
You may find relief from vaginal dryness using water-based lubricants or vaginal moisturizers, which can be found at most grocery and drug stores. Vaginal moisturizers differ from lubricants. They are to be used regularlynot just during sexto replenish vaginal moisture and relieve vaginal dryness. Do not use petroleum jelly for this purpose oil-based products can cause irritation.
If using water-based lubricants or vaginal moisturizers does not improve your symptoms, hormones may help. Local vaginal treatments are often used to treat this symptom and provide lower hormone doses to the rest of the body than a pill or patch.
Hormones arent the only option for treating vaginal dryness and dyspareunia. The U.S. Food and Drug Administration has approved two non-hormone medicines, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause. Your doctor can tell you about the risks and benefits of these medicines.
A Physical Therapy Treatment
Though women may not immediately turn to physical therapy when struggling with painful sex, it may be a useful option.
An overactive pelvic floor can spasm during intercourse, Stein said. If it keeps going, you could end up with sex becoming a turn-off. she said. Anxiety may then lead to more tightening. The author of the book, Heal Pelvic Pain, Stein said many physical therapists perform an internal and external exam. They work on alignment, manual therapy for pain and massage to lengthen muscles. They teach women how to use therapeutic wands to release inner trigger points and how to use dilators to open up the vagina.
Stein teaches diaphragmatic breathing and encourages women to meditate, do yoga, tai chi, or anything to calm the nervous system down.
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Lgbtqia+ And Sex During Menopause
A person born with ovaries will experience menopause, but the experience may vary, depending on their gender identity.
If the person undergoes surgery to remove the ovaries before midlife, the effects of menopause will start to appear soon after the procedure. Effects may be more abrupt and feel more severe than with natural menopause, as they will not develop gradually. Male hormone supplements may either reduce or complicate these effects.
Females in same-sex couples who experience menopause naturally at midlife may find that their partner can offer positive support regarding changing sexual emotions and activity. According to some research , however, same-sex couples may also find that stigma and societal pressures add to their stresses and make it harder to access support.
People who were assigned male at birth but have transitioned to female may use hormone therapy for life. As long as they continue treatment, menopause-type effects should be limited. Their libido is unlikely to change due to hormonal fluctuations, but age-related changes may still affect it.
Theres Nothing Wrong With Needing Help In The Lubrication Department
Whether you decide to opt for extra hormones or not, using vaginal moisturizers like Replens and regular ol lube can help ease vaginal discomfort. In fact, Tami Rowen, M.D. an obstetrician and gynecologist specializing in sexual health at the University of California San Francisco, highly recommends using a lubricant to help make sex more enjoyable if you experience vaginal dryness. If youre new to lube, its important to know that there are several types: silicone-based, oil-based, water-based, and hybrids. Generally, water-based lubes that dont contain glycerin are a good choice because theyre suitable for people with sensitive skin. Further, Dr. Rowen suggests buying a lube that mimics the natural pH of your vagina. Changes to its natural state can cause an overgrowth of bacteria and lead to infections like bacterial vaginosis, according to the Cleveland Clinic. . Before heading to the store, you can do research online to find a product that fits within this scale. Dr. Rowen recommends lubes like Almost Naked by Good Clean Love . This one falls between 4.2 – 4.7 on the pH scale, according to the manufacturers website.
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What Causes Dyspareunia
In many cases, you can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, the pain can be resolved if you become more relaxed, increase foreplay or if you use a sexual lubricant.
In some cases, you have painful intercourse if one of the following conditions is present:
Like women, men can also feel pain if there is not enough vaginal lubrication during sex. This can be solved by using a sexual lubricant. In men, painful sex can be caused by certain penile disorders:
- Foreskin damage: Damage to the foreskin caused by rubbing or tearing can lead to pain.
- Sexually transmitted infections : Yeast infections or infections under the foreskin, as well as common STIs like genital herpes or gonorrhea, can make sex painful.
- Penis deformities: Peyronies disease or other deformities of the penis can cause painful intercourse.
- Painful erections: A condition such as priapism can lead to persistent, painful erections.
What Causes Sex To Hurt
Pain during sex can be experienced at any age, but it may be more common around and after the age of 50 years. Any time there is a significant drop in estrogen in your body, you are at risk of experiencing pain with intercourse. Menopause is the most common reason for pain during sex, but there may be other factors at work in your life. Its important to talk to a health care professional about any pain felt during intercourse, as there are many things you could do to make intercourse more pleasurable and enjoyable.
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How Do I Talk To My Doctor About Painful Sex
Talk openly with your healthcare provider about any pain during sexual intercourse. Some questions your healthcare provider may ask you are:
- Where is the pain occurring?
- How often does the pain occur?
- How long have you been having painful intercourse?
- What does the pain feel like?
- What medications are you taking?
- Have you had any prior surgeries in the area?
- Have you been treated for any conditions of the vagina?