Do You Avoid Having Sex Due To Pain?

Life is supposed to be full of pleasures, big and small. When sex becomes painful, it becomes a problem physically and mentally. For those who have never experienced pleasurable sex, it can seem like an impossibility, something out of reach. Many of us believe that pain or discomfort during sex is to be expected at a certain point in our life. This is NOT true. Sex should be pleasurable. It's also important to talk about, as this is an issue that affects many people and is 100% treatable. 

Dyspareunia, or painful intercourse, can be caused by a variety of different reasons, including psychological concerns to structural problems. Many women experience painful intercourse at some point in their lives. It can be defined as recurrent or persistent genital pain that occurs either just before or during intercourse. Oftentimes, pelvic floor dysfunction plays a role in this condition.

Did you know that a whopping 84% of us experience painful intercourse following the birth of our children?!

This isn’t surprising considering what our abdominal and pelvic floor muscles go through during a C-section or vaginal delivery. We need time to heal. At least 6-8+ weeks to be exact. But after our scars have healed and we are “cleared” for sex by our OBGYN or midwife, oftentimes, our bodies are still not ready for sex. Take home message, ladies: you are not “damaged” if intercourse is still painful after your 6-week check-up. It will get better. You may want to consider seeking help from a pelvic floor PT to make sure you are on the right track and have the support you need to get back to all of your favorite activities.

Symptoms 

Symptoms of dyspareunia are: 

• Throbbing pain that lasts for hours after intercourse 
• Burning or aching pain 
• Deep pain during thrusting 
• Pain with penetration, even with putting in a tampon 
• Pain only at penetration 

Factors to Consider

• Medications: they may be a major culprit! Birth control, blood pressure, and allergy meds may cause vaginal dryness. 
• Anxiety or depression can affect both libido and sexual arousal. 
• Conditions such as IBS, past surgical history, and ovarian cysts can play a role as well. 
• Lack of estrogen during breastfeeding, early postpartum as well as during menopause can lead to vaginal dryness, thinning of the vaginal tissues, and decreased libido. 
• History of sexual abuse or other emotional factors. 

Physical Causes 

Although the problem can affect both men and women, it is more common in women. Women with dyspareunia have pain in the labia, clitoris, and vagina. If the pain is acute and occurs because of deep penetration, it can be due to any of the following:

•  Allergic reaction to douches, spermicides, and clothing
• Vaginal dryness
• Pelvic floor muscle spasm and or dysfunction 
• Atrophic vaginitis, which is a common condition in postmenopausal women that causes thinning of the vaginal lining
• Side effects of drugs, such as tamoxifen and antihistamines
• Endometriosis, which is a painful condition that causes the tissue of the uterine lining to migrate and grow abnormally inside the pelvis 
• Valvular vestibulitis is inflammation of the area that surrounds the vaginal opening
• Skin diseases affecting the vaginal area, for example, lichen sclerosis and lichen planus 
• Sexually transmitted diseases, vaginal yeast infections, and urinary tract infections
• Physical trauma
• Fibroids or non-cancerous tumors growing on the wall of the uterus 
• Ovarian cysts, which are cysts resulting from a buildup of fluid inside the ovary 
• Pelvic inflammatory disease (PID)–PID is an inflammation of the female reproductive organs because of an infection
• Hysterectomy and other pelvic surgery 
• Some cancer treatments

It's always recommended to talk to your OB-GYN about any pain or discomfort you are experiencing in addition to a pelvic floor therapist so you can check for muscular dysfunction and medical conditions.

Psychological Causes 

• Depression, fear, and anxiety contribute to vaginal dryness and muscle spasm and can inhibit sexual arousal
• In addition to this, stress can also trigger tightening of the pelvic floor muscles that results in pain
• Psychological trauma 

Diagnosis 

Dyspareunia can be diagnosed based on the presenting symptoms. Your medical and sexual history along with a physical examination will help the doctor determine the cause of pain during intercourse. A common presenting complaint of dyspareunia is pain on touching the genitals, and early and deeper penetration. The doctor will assess the symptoms and ask questions about the exact location, length, and time of the pain.

So what can be done? Check the list of side effects on your medication bottles. Talk to your primary care physician about alternative medication options. Find a mental health counselor in your area. Find a pelvic floor physical therapist who can help you find the root cause of your painful intercourse. This isn’t something you have to live with forever. This doesn’t have to be a taboo topic to discuss. There are healthcare professionals, like myself, who can help you on your healing journey towards great sex.