Conditions and Management

Sexual intercourse is meant to be pleasurable, but for some women, it can be a source of considerable physical pain. If you are experiencing pain during sex, you may find it reassuring to learn that it is not uncommon and is generally very treatable. Although it may be uncomfortable to talk about it, your doctor can help you find a solution. Here is a look at some of the management and treatment options for pain during sex.

Diagnosing Pain During Sex

Before finding the best way to address painful sex, it is important to identify its cause. Your doctor will begin by compiling a thorough medical history, asking you questions about when your pain begins, where you are feeling it, and whether it happens in every position or with every partner.

They may also ask you whether any nonsexual activities cause pain in the area and whether you are experiencing other symptoms such as itching, burning, or irritation. Your doctor might ask questions about your childbirth and surgical history. It is important to be forthcoming and answer these questions as truthfully as possible.

Next, they will carry out a pelvic exam to look for signs of skin irritation, anatomical issues, or infections. They may also conduct a visual exam of your vagina using a speculum to keep it open. If this causes you pain, you can ask the doctor to stop the exam. A pelvic ultrasound may also be used if certain causes of painful intercourse are suspected.

Treatment

The precise treatment your doctor will recommend depends on the cause of your pain. Here is a look at some of the most common approaches.

Medication

If a medical condition or infection is behind your pain during intercourse, treating the cause may be enough to bring about relief. If you are taking any medications that can cause lubrication issues, changing to a different medication may also lead to improvements.

Painful intercourse for postmenopausal women is often caused by insufficient lubrication due to low levels of estrogen in the body. Birth control pills, menstruation, pregnancy, breastfeeding, and some types of antiestrogen medications may also result in decreases in estrogen production that lead to dryness and pain during sex. Applying topical estrogen directly to your vagina may alleviate this problem; there are also other medications that can help.

Other Types of Treatment

There are also some nonmedication approaches that may help with painful intercourse.

Counseling or Sex Therapy

For some women, painful sex is psychological and may be linked to trauma or low self-esteem. Even in cases where painful sex has a medical cause, you may develop a negative emotional response to any sort of sexual stimulation, even after the pain has been treated, if sex has been painful for a long time. Moreover, in cases where you and your partner have avoided getting intimate due to your pain, it may be necessary to seek outside help in restoring sexual intimacy and improving your communication surrounding these issues. A counselor or sex therapists can be very helpful. In addition, cognitive behavioral therapy can help you to change any negative thought patterns and behaviors that you have concerning intercourse.

Pelvic Physical Therapy

For some women excess tension or dysfunction of the pelvic floor muscles contributes to painful sex. Referral to a special physical therapist with expertise in this area can help to alleviate this problem.

Changing Positions

For women who experience sharp pain during thrusting, switching to different positions may provide some relief. For example, doctors recommend that women try being on top as they may be able to regulate penetration to a more comfortable depth from this position.

Don’t Skip Foreplay

Foreplay can help to stimulate your body’s natural lubrication, which can make sex more comfortable. Try to delay penetration until you feel completely aroused to see if your pain subsides. Many women report that sex is less painful when they are relaxed and can take their time.

Use Lubricants

There are many personal lubricants on the market that can help to make sexual intercourse more comfortable. Water or silicone based lubricants are frequently good options. If you are using latex condoms for birth control or STD prevention, be sure to avoid oil-based lubricants as they may lead to condom breakage.

Avoid Irritating Products

If you have pain during sex, it could also be due to irritation from certain types of products. Avoid using vaginal perfumes, scented toilet paper, sanitary pads, and bubble baths. Switch to underwear that is 100 percent cotton, and try a gentler laundry detergent to see if any of these products could be related to your pain.

Reach Out to the Women’s Healthcare Professionals

There are many reasons you may be experiencing painful sex, but you do not have to continue suffering. The women’s healthcare professionals at Raleigh Gynecology & Wellness can help to identify the cause of your painful intercourse so you can manage it effectively and restore normal sexual function. Call us today to set up your appointment with a gynecologist or to schedule an appointment online.

Sex is supposed to be pleasurable, but for some women, the experience can be painful. Whether you experience pain every time you try to have intercourse or it only happens occasionally, it is important to explore what could be causing the problem so you can take steps to address it. Here is a look at some of the most common reasons women experience painful sex and how you can alleviate it.

What Is Painful Sex?

Painful sex, also known as dyspareunia, is characterized by pain in the area of the pelvis, labia, or vagina that is felt either during sexual intercourse or immediately afterward. It is so common that it has been described in medical literature as far back as the ancient Egyptian scrolls. However, it is not known precisely how many women experience it because the symptoms can vary, and many women are not comfortable discussing it with their doctors.

The pain may manifest in several ways. Some women report a deep pain, while others experience a sharp pain, a burning sensation, or a feeling of great discomfort. Some women might also experience symptoms such as muscle tightness, muscle spasms, or pelvic cramping.

Types of Painful Sex

There are many types of dyspareunia, so the condition is often broken down into different categories depending on its location and duration.

Location of Painful Sex

First, the location of the pain is considered. There are two main types: entry pain and deep pain.

Entry Pain

Also known as superficial or introital dyspareunia, this pain is felt around the vaginal entrance during initial penetration. It may be related to an infection, injury, or inadequate lubrication.

Deep Pain

Sometimes referred to as collision dyspareunia, this pain is felt during deep penetration and may be worse in specific sexual positions. It may be felt in the cervix or the lower abdomen, and it is sometimes linked to previous surgery or a medical condition.

Duration of Painful Sex

Painful sex is also described in terms of its duration.

• Primary Pain: Pain during intercourse that you have always experienced since you first became sexually active.
• Secondary Pain: Pain that develops after a time of painless sex.
• Complete Pain: You experience pain every time you have sex.
• Situational Pain: You only experience pain at certain times during sex.

Causes of Painful Sex

Here are some of the most common causes of painful sex.

Insufficient Vaginal Lubrication

Many cases of painful sex can be traced to insufficient vaginal lubrication. There is often a psychological component to this; women may find that relaxing a bit before sex or engaging in prolonged foreplay can help them reduce or eliminate pain. You can also purchase sexual lubricant and apply it prior to having sex.

Vaginal Atrophy

The lining of the vagina can sometimes lose thickness and moisture and may even become thin and dry. This can be due to hormonal changes, medication, or menopause. A gynecological exam can diagnose vaginal atrophy, and the treatment will depend on the cause identified. Hormone therapy and lubricants are two common recommendations for women with this issue.

Vaginismus

Vaginismus occurs when the muscles of the vagina automatically tighten up out of fear of vaginal penetration. It is a reaction that cannot be controlled, and it can even occur in women who have previously enjoyed painless sexual penetration. However, it does not always impact the ability to get aroused or enjoy other forms of sexual contact. It is often caused by worries your vagina may be too small to accommodate your partner, negative beliefs about sex, a bad sexual experience, or a medical condition.

There are several possible treatments for vaginismus. Psychosexual therapy, a type of talk therapy that helps you understand your feelings about sex and your body and make changes, is one helpful approach. Pelvic floor exercises, physical therapy, vaginal trainers, and relaxation techniques such as mindfulness can also help you relax the vaginal muscles.

Injury to the Vagina or Vulva

For some women, painful sex can be attributed to injuries to the vagina or vulva, particularly for women who have given birth in the past. These injuries could include a tear that occurred during childbirth or a cut from an episiotomy made during labor to facilitate childbirth.

In addition, having intercourse too soon after childbirth or surgery can also cause painful sex, and this will often go away on its own if you give yourself sufficient time to heal.

Pelvic Inflammatory Disease

In pelvic inflammatory disease, or PID, the tissues deep within the vagina and pelvis experience severe inflammation, and this causes the pressure of intercourse to lead to deep pain. This is usually caused by a sexually transmitted infection, and symptoms include pain in the lower abdomen and stomach as well as lower abdominal pain. It can usually be treated with antibiotics, but your partner should get tested and treated to avoid a recurrence.

Keep in mind, however, that PID is not always sexually transmitted. For example, sex itself can sometimes allow bacteria to enter the reproductive system and infect your organs.

Reach Out to the Women’s Wellness Team

If you are experiencing painful sex, reach out to the women’s healthcare team at Raleigh Gynecology & Wellness to set up an appointment. Their highly trained gynecologists and nurses can help manage a broad range of gynecological conditions and issues.

Under normal circumstances, your vaginal lining is lubricated with a fluid that keeps it elastic and thick. However, there are many reasons that the tissue in your vagina can sometimes become dry and thin, which can lead to significant discomfort during sex, while exercising, or even while sitting down. Here is a look at what can cause this frustrating problem and how you can address them through different treatment options for vaginal dryness.

What Can Cause Vaginal Dryness?

Many times, vaginal dryness stems from a drop in a woman’s estrogen levels as one of this hormone’s many functions is helping the vagina maintain its natural lubrication. However, it can also be caused by medication and lifestyle-related behaviors.

Reduced Estrogen Production

Decreases in estrogen production can be caused by perimenopause, menopause, or surgical menopause. It may also result from menstruation, birth control pills, or antiestrogen medications. Pregnancy, childbirth, breastfeeding, and chemotherapy may also lead to reduced estrogen production.

Medication

Besides medications that specifically reduce estrogen production, such as Tamoxifen, other types of drugs can also lead to vaginal dryness. These include birth control pills, antihistamines, cold medications, antidepressants, asthma medication, and allergy medication.

Lifestyle

Vaginal dryness may also result from drinking alcohol, smoking cigarettes, douching, stress, or allergies to fragranced personal products such as detergents and toilet paper.

Treatments for Vaginal Dryness

Because there are so many potential causes of vaginal dryness, it is essential to identify the reason you are experiencing this problem so you can address it properly. While vaginal dryness due to product allergies can be easy to correct, if you suspect it could be related to low estrogen, you will need a gynecologist to diagnose the problem and recommend treatment. Outlined below are the top treatment options for vaginal dryness.

Prescription Treatments for Vaginal Dryness

If you have low estrogen, your doctor might prescribe a low-risk topical form of estrogen therapy aimed at promoting lubrication and elasticity. Here are some examples.

Vaginal Cream

These prescription products use an applicator to deliver cream with a low dose of estrogen into the vagina.

Vaginal Ring

This is a flexible, soft ring that you insert into your vagina. It will remain there and steadily release low amounts of estrogen into the vaginal tissue for about three months, at which point you remove it and insert a new ring

Vaginal Tablet

This is a type of medication that is applied using an applicator that is similar to that of a tampon. Much like a vaginal ring, this tablet will slowly release low doses of estrogen into vaginal tissue.

Over-The-Counter Vaginal Dryness Treatments

There are some over-the-counter treatments for vaginal dryness that may be helpful in cases where the dryness is not linked to low estrogen levels.

Lubricants

A water-based personal lubricant can be used when you have sex to enhance moisture levels. Be sure to avoid oil-based lubricants, however, as they can cause irritation and make condoms prone to breakage.

Vaginal Moisturizers

Over-the-counter vaginal moisturizers are available that can be inserted every few days to replenish the natural moisture in your vagina.

Lifestyle Changes to Improve Vaginal Dryness

Here are some recommendations for lifestyle changes that can help you restore your vagina’s natural moisture levels.

• Avoid douching or using personal hygiene products formulated with dyes or fragrances.
• Wear cotton underwear that allows your vagina to breathe, avoiding clingy fabrics and thongs that can worsen irritation.
• Avoid using hot water to clean your vagina.
• Have sex regularly with sufficient foreplay and arousal in order to stimulate your body’s natural vaginal moisture production.
• Eat foods rich in phytoestrogens, such as soy, seeds, tofu, berries, and nuts.

How Long Does it Take to See Improvements?

If your vaginal dryness is not linked to estrogen production, it should return to normal not long after you have identified the cause and taken action to correct it.

Women in perimenopause and menopause may experience persistent vaginal dryness, in which case help from a gynecologist is needed.

For women who are breastfeeding, vaginal dryness may continue throughout nursing, although a doctor may be able to help you find some relief.

When to See a Doctor

If you have ruled out any lifestyle-related causes, such as irritating products, and your vaginal dryness persists, you should see a gynecologist. They can discuss your symptoms with you and make a diagnosis with a pelvic exam; they may also carry out blood tests depending on the suspected cause.

You should also see a doctor if your vaginal dryness is accompanied by any of the following symptoms:

• Abnormal odor or discharge
• Bleeding after sex
• Painful sex
• Persistent vaginal swelling
• Severe itching

Reach Out to the Women’s Healthcare Team at Raleigh Gynecology & Wellness

Vaginal dryness can be very unpleasant, but there are lots of treatment options that can provide relief. The women’s healthcare team at Raleigh Gynecology & Wellness can help identify the cause of your vaginal dryness and recommend effective treatments. Contact them today to set up an appointment.

Your body undergoes a lot of changes during pregnancy, and eventually, many familiar activities will start to feel different. It is not unusual for sex to be uncomfortable when you are pregnant, but how can you tell what is normal and when you should be concerned? Read more about painful sex in this article.

In some cases, painful sex during pregnancy has a very simple cause. For example, because pregnancy makes many women need to use the bathroom more often, it could just be the pressure of a fuller-than-usual bladder making sex uncomfortable. Swelling in your tissues might make your labia feel larger and your vagina feel tighter, which can also cause some pain.

However, other changes your body undergoes can also cause or contribute to painful sex. Here are five major causes of painful sex during pregnancy and what you can do about it.

Uterine Growth And Cramping

In the first trimester of pregnancy, which lasts through the end of the 13th week, you will start to notice your body changing in ways that can cause some pain during sex. Uterine cramping is not uncommon in early pregnancy, and it often leads to painful sex. As your uterus begins to expand to accommodate your growing baby, you may start to experience mild pain during sex. However, this is normally nothing to worry about.

As your pregnancy progresses, your uterus will stretch further to support the growing baby. By the time you reach your third trimester, your uterus will be quite heavy, and doctors report that many of the issues women encounter with painful sex while pregnant are related to the bulk of their pregnant uterus and the way that they are carrying the baby.

Infections

It can be difficult for your body to stay on top of all the chemical changes taking place in your vagina during pregnancy. One of these is the presence of more sugar within your vaginal secretions that yeast can feed upon, which is one reason that expectant mothers are especially vulnerable to yeast infections. Although they can occur at any time in your pregnancy, they are especially common in the second trimester. A yeast infection can cause you to feel burning both during and after intercourse. Bladder infections and bacterial vaginosis are also more common in pregnancy due to the physical and hormonal changes your body experiences.

Round Ligament Pain

Round ligaments are cordlike structures within your pelvis connecting the front of the uterus with the groin. They work to support the uterus and hold it in place. As they stretch during pregnancy, it can lead to serious discomfort, and sex can exacerbate it. It may feel like a sharp and stabbing internal pain, or it could cause a duller ache that suddenly occurs with certain movements during sex. Round ligaments can also sometimes cause pain when rolling over in bed, getting dressed, or walking while pregnant.

Pelvic Congestion

If the pain you are experiencing during sex feels like a deep ache inside your pelvis, it could be due to pelvic congestion. This is caused by the natural enlargement of the veins and blood vessels in the pelvis during pregnancy and can feel like a heavy pressure inside the vagina.

Vascular Changes

During pregnancy, increased blood flow and hormonal changes can cause your veins to enlarge and not perform as efficiently as they do when you are not pregnant. When you have enlarged veins in your pelvis or on your vulva, it can cause painful sex, particularly during the second trimester of your pregnancy.

What To Do About Painful Sex During Pregnancy

The cause of your discomfort should guide how you address painful sex during pregnancy. If it is related to the size of your belly or the position of the baby, it may be time to carefully experiment with new positions and moves. Pillows can help to ease the pressure on certain parts of your body, while lubricant can help if your discomfort is related to swelling.

Although pain during sex is usually nothing to be concerned about, particularly if it is mild, it is still important to seek medical advice if you are experiencing significant pain or bleeding or you are having a high-risk pregnancy.

This is particularly important if you also have urinary symptoms, such as a burning feeling during urination or the urge to urinate frequently as it could be a sign that you have an infection.

Ultimately, you know your body best. If you feel like something isn’t right or you are worried about pain after sex, it is always best to have it checked to ensure your pregnancy remains healthy.

Reach Out to Raleigh Gynecology Wellness

If you are experiencing painful sex, determining the cause can help you find relief. For more information about managing painful sex, get in touch with the healthcare professionals at Raleigh Gynecology Wellness today.