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  • Michael Frey, MD

Why Does Sex Hurt?



Pain during sex, or dyspareunia, can cause problems in a couple's sexual relationship. Painful intercourse can have negative emotional effects in addition to physical pain. There are many possible causes and many effective treatment options available. If you have pain during sex your body may be trying to tell you something is wrong, so don't ignore it.


What causes pain during sex (dyspareunia)?

  • Lack of lubrication: In many cases, a woman can experience pain during sex if there is not sufficient vaginal lubrication.

  • Fibroids: Benign growths in the uterus.

  • Vaginismus: Spasms in the vaginal muscles, mainly caused by the fear of being hurt or prior trauma.

  • Vaginal infections: These conditions are common and include yeast infections.

  • Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.

  • Menopause: The vaginal lining can lose its normal moisture and thickness and become dry, thin, and inflamed.

  • Intercourse too soon after surgery or childbirth

  • Sexually transmitted infections (STIs): These may include genital warts, herpes sores, or other STIs.

  • Injury to the vulva or vagina: These injuries may include a tear from childbirth or a cut from shaving.

  • Narrow Vagina: Virginal women, post-menopausal women, and women who have undergone radiation therapy may suffer from a narrow vaginal tube. Other symptoms may include bleeding after sex.

  • Medical conditions: Such as a urinary tract infection, constipation, or irritable bowel syndrome.

  • Emotional and psychological factors: Anxiety, fear, and depression can inhibit sexual arousal and contribute to vaginal dryness or vaginismus. Stress can trigger a tightening of the pelvic floor muscles, resulting in pain. A history of sexual abuse or sexual violence may contribute to dyspareunia.

  • Vulvodynia: A chronic pain condition that affects the vulva -- including the labia, clitoris, and vaginal opening.

  • Loss of desire for sex: This is a separate problem in and of itself but when the desire goes, sex becomes a stressor rather than a pleasure. This can lead to pain with intercourse which can negatively feedback on sexual desire.

  • Skin disorders affecting the genitalia: such as eczema, lichen planus, lichen sclerosis, or other skin problems in the genital area. Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.


Types of sexual pain

  • pain with deep penetration

  • pain with superficial penetration

  • pain after intercourse

  • pain with specific partners or circumstances

  • pain along with burning, itching, or aching

Tests that may be ordered

  • pelvic ultrasound

  • culture test to check for bacteria or yeast infection

  • urine test

  • counseling to determine the presence of emotional causes


How dyspareunia is treated

Antibiotics: If your pain is caused by an underlying infection or condition, you may be treated with:

  • antibiotics

  • antifungal medicines

  • topical or injectable corticosteroids

Vaginal moisturizer:

If vaginal dryness is present, you may need a moisturizer for the vagina.


Sex lubricant:

-Vaginal lubricants (for when you're having sex). These are all available online. You do NOT need a prescription.

Good Clean Love— This vegan-friendly water-based lubricant is free of parabens.

Wet Platinum Premium Lubricant — A silicone-based lubricant with minimal chemical additives. Be aware that silicone-based lubricants will stain sheets.

Überlube Luxury Lubricant --- Silicone-based lubricant with Vitamin E. Organic Glide — Oil-based lubricant made with olive fruit oil, argania kernel oil, and resveratrol ferment extract. Very popular with my patients because it lasts a long time and works well.

Zestra Essential Arousal Oil --- Blend of botanical oils and extracts with no chemicals, hormones, parabens, or drugs. Peaks in just 10 minutes and lasts up to 45 minutes.


Estrogen therapy:

Low estrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of estrogen to the vagina.


If you have a vaginal tube that is too narrow for your partner's penis.


What else you can do to reduce symptoms:

  • Have sex ONLY when you and your partner are relaxed.

  • Communicate openly with your partner about your pain.

  • Empty your bladder before sex.

  • Take a warm bath before sex.

  • Take an over-the-counter pain reliever before sex.

  • Apply a Vagikool ice pack to the vulva to calm burning after sex.

  • After childbirth, wait at least six weeks before resuming sexual intercourse.

  • Encourage natural vaginal lubrication with enough time for foreplay and stimulation.


Alternative therapies


Sex positions

In general, you should seek a position that does not cause discomfort during intercourse and, if you are seeking pregnancy, have sex on fertile days. Control the depth of penetration. Avoid "girl on top" position if it is painful. The best positions are usually: missionary and spooning.


Consider additional erotic activities that don’t include penetration. Penetration can be the side dish for sex while the other activities dominate. Pleasure is the goal, so creatively figuring this out is key. Manual stimulation using your hands on your partner’s external parts is a stellar alternative to internal penetration.

Outlook

Alternatives to sexual intercourse may be useful until underlying conditions are treated. You and your partner can use other techniques for intimacy until penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual masturbation may be satisfying alternatives.


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