Painful Sex Part 3 | What to do if sex hurts

Painful sex seems to be the “dirty secret” that many of my female clients struggle with. They often have intercourse just as frequently as other couples do, but hide the pain from their partner. Often because painful sex is simply not spoken about in culture, or seen in pornography. Many women are left thinking, “well...I guess this is it”.

This is NOT it.

Many have never spoken to a doctor about the issue of painful sex.

Others have been brushed off (including me) when they sought help.

The doctor often sees nothing wrong after performing an examination and simply suggests using more lube because they assume it is because of vaginal dryness.  But in many cases this is simply not the solution, particularly in younger women who don’t have any existing lubrication issues.

The truth is, you can get relief through treatment and counselling, and telling a partner is a good place to start.

Researchers have found that communication on this issue improves sexual satisfaction for both people. I can attest to this. Communication is key to having a truly mind blowing sex life.

You may also change your sexual repertoire and ultimately find intercourse less painful.

Painful sex is fairly common (but shouldn’t be)

Painful sex can occur at any age. It may also come and go.

In a study  published in the International Journal of Obstetrics and Gynaecology, 7.5 percent of nearly 7,000 sexually active women in the U.K. said they had had pain during sexual intercourse within three months prior to the study.

The estimates of how many women experience pain during intercourse over their lifetime range from 10 to 28 percent with the most common forms of pain being post menopausal in nature, and associated with vulvodynia, but more on that another time.

Pain after menopause

Dropping oestrogen levels bring on vaginal dryness and other symptoms in about half of all postmenopausal women.

Vaginal dryness can even make riding a bike unpleasant. Yet many women suffer without seeking help.

Dr. Mary Jane Minkin, an OB-GYN, and clinical professor at Yale School of Medicine in Connecticut says that “Many women greet this with resignation.”

Researchers have found that from 44 percent to 78 percent of women with vaginal dryness say that intercourse was painful. There are a number of products on the market that can boost oestrogen levels to aid in vaginal lubrication, and for those women who are nervous of synthetic hormones, there are non-oestrogen options available too. It is worth talking to your gynaecologist or doctor about which options would be best for you if you do suffer from vaginal dryness.

 

Painful vulva

Even without dryness, a woman may have pain in their vulva — the external part of female genitals.

When the pain has no obvious cause, it’s known as “vulvodynia.” This condition occurs, on average, around the age of 30, in 3% – 14% of women.

The most common form of vulvodynia causes a sharp or burning pain that occurs near the entrance to the vagina when it is pressed.

It may also cause some women feel pain the first time they insert a tampon.

In other women it can come from sitting a long time or wearing tight pants — or even sometimes without any pressure or touch. According to a study, the pain from vulvodynia often lingered after sex for women of any age.

According to the National Vulvodynia Association researchers have speculated about a range of causes, including weakness in the pelvic floor, hypersensitivity to the yeast common in that area (Candida), or various kinds of nerve damage. There is currently no definitive reason.

Effect on relationships

About a third of partners are unaware of the pain that their partner is experiencing.

Women who experience pain during sex may become wary that any affectionate touch is an overture, and both members of the couple tend to find it harder to talk about sex.

The findings of the study out of the United Kingdom support the above conclusion. Women reporting pain were more likely to say that they didn’t share their partner’s sexual preferences or appetite, but they were no less likely to be happy with the relationship overall.

Rosen has advised women to open up. “Partners appreciate the information. They don’t want the woman to be in pain,” she says.

 

The goal is to experiment and “vary the script,” Rosen suggests.

It’s best to have sex with an upbeat goal — liking your partner’s pleasure, for example — rather than to avoid losing the relationship or another feared outcome.

When you’re motivated by avoidance, both you and your partner are less likely to be happy.

 

Case Study

Mark and Rita (their names have been changed to protect their privacy).

The couple enjoyed frequent intercourse for a decade, and then when both had entered their 50s, their sex life stopped.

“When I questioned her, I got vague answers,” Mark said.

By his 60s, Mark was longing for sex and considered a divorce. He asked Rita to see a counselor with him.

In their sessions, Rita admitted that intercourse hurt, and they agreed to try having sex again.

“The therapist said ‘This is your homework. Come back when you’ve done it,’” Mark said.

They haven’t returned.

Mark said they’ve tried lubricants and different positions, but nothing seems to work.

“The pain is instantaneous. She flinches,” he said.

Mark senses that Rita would be fine without any sexual activity at all.

“She’d probably let me do it, but I don’t want to,” Mark said. “I don’t get the sense she wants to, except to keep me from leaving.”

What you can do

Cognitive behavioural therapy (CBT) has the most scientific support.

Women learn to manage thoughts and emotions about the pain. For example, the fear that it’ll never go away, as well as shame and anger.

In studies of a small group of women with provoked vestibulodynia, teams found that surgery, biofeedback, and CBT all gave participants measurable improvement that lasted for two and a half years.

In a separate recent study, 10 weekly sessions with a physical therapist reduced pain during intercourse more effectively than the standard alternative of applying lidocaine, a desensitising ointment.

It is also advisable to look for an expert in pelvic floor physical therapy, which includes those who treat stress urinary incontinence.

Be sure you have a gynaecologist or doctor you feel comfortable talking about this with, and a sex therapist, and don’t give up hope. You and your amazing body are designed to be able to enjoy all of the wonders that sexual intercourse can bring.

Got a question about sex? Send your questions and I’ll answer them! What’s your question?

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