Pain with Sex
For many women, the experience of pain during sexual intercourse is an all-too-common and distressing issue. It’s estimated that up to 75% of women will experience pain with sex at least once in their lives. This discomfort can manifest in different ways, ranging from tightness of the vaginal muscles (known as vaginismus) to more superficial or deep pain in the vulvar or intravaginal areas.
While dyspareunia specifically refers to pain with sex, some women may experience pain even without sexual activity, a condition known as vulvodynia. In this blog, we explore the various causes of pain with sex and highlight treatment options that can help women find relief and restore their sexual well-being.
Understanding the Causes of Pain with Sex
Pain during sexual intercourse can have numerous underlying causes, including other pain syndromes, genetics, hormonal factors, inflammation, musculoskeletal or neurological mechanisms, psychosocial factors, and structural defects. Vulvodynia, a chronic genital pain condition, affects an estimated 10% to 28% of reproductive-aged women in the general population and can contribute to pain during sex. Additionally, deep dyspareunia can result from visceral disorders such as interstitial cystitis, pelvic inflammatory disease, endometriosis, adhesions, pelvic congestion, and fibroids. Pain syndromes like irritable bowel syndrome, fibromyalgia, and musculoskeletal dysfunction can also overlap and be associated with dyspareunia and vulvodynia.
Psychosocial Factors and Other Root Causes
Psychosocial factors play a significant role in pain with sex. A history of abuse or not feeling safe can be root causes for some women. Additionally, engaging in sexual activities when one does not want to can lead to pain. Lack of sufficient foreplay or inadequate lubrication can also contribute to discomfort during intercourse. Identifying and addressing these underlying factors is crucial for effective treatment and healing.
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Tailored Treatment Approaches:
To effectively address pain with sex, it is essential to identify and treat any specific causes that may be contributing to the condition. For instance, if a vaginal infection or musculoskeletal issue is present, targeted treatment should be employed. Multimodal treatment approaches that encompass physical, emotional, and behavioral aspects of pain are recommended. Here are some treatment options commonly employed:
- Topical Estrogen Therapy: Vulvovaginal atrophy, caused by decreased levels of estrogen, is a common issue in aging women. Topical estrogen therapy can help restore normal vaginal pH levels, increase cell numbers, and promote revascularization of the epithelium. This can alleviate dryness and dyspareunia in these cases. Topical DHEA therapy can help as well. Before starting treatments like this, it is advisable to get your hormone levels checked as well as throughout treatment. In addition, natural versions of hormone therapies can work really well for many women and can cause less side effects.
- Natural Anti-inflammatories: Certain natural anti-inflammatory agents may help reduce inflammation and alleviate pain. These can be used as part of a comprehensive treatment plan for pain with sex.
- Botox Injections: In some cases, Botox injections into the pelvic floor muscles can help relax the muscles and provide relief from pain. This approach may be particularly beneficial for individuals with musculoskeletal issues contributing to dyspareunia or vulvodynia.
- Pelvic Floor Physical Therapy: Pelvic floor physical therapy is a crucial adjunct to most treatments for pain with sex. It involves techniques such as biofeedback, dilators, electrical stimulation, education, and multidisciplinary approaches. Physical therapy can help relax the pelvic floor muscles, retrain pain receptors, and improve sexual function.
- Addressing Root Causes: Perhaps the most important aspect of treatment is identifying and addressing the root causes of pain with sex. This may involve a comprehensive evaluation of an individual’s medical history, lifestyle and more. The mental-emotional component is essential as well. If you have trauma or are feeling unsafe in any way, this can lead to pain with sex. Often times in these scenarios, we may find ourselves dissociating during sexual encounters. If this happens, you body may be stimulating a stress response, which for many women, can lead to lack of responsiveness and lubrication in their genitals as well as pain.