When Sex is a Real Pain

Many factors may cause women to feel pain during sexual intercourse. Rochester doctor: ‘Sex should never be painful’

By Deborah Jeanne Sergeant

For a variety of reasons, many women experience pain with sex. Sexually transmitted diseases, vaginal infections, low hormone levels, vulvar skin issues, very tight or weak pelvic floor muscles, endometriosis and unknown issues can cause women pain during sex, for example.

Age matters as well.

Physician Vanessa Barnabei, PhD, president and CEO of UBMD Obstetrics and Gynecology, explained that for post-menopausal women, it’s most often due to lower estrogen levels which cause vaginal dryness and thinning of the vaginal tissue.

“That decreases the level of natural lubrication in the body, which makes sex very uncomfortable,” said the professor and chairwoman of the department of obstetrics and gynecology at Jacobs School of Medicine & Biomedical Sciences.

Women of any age may experience chronic pain, vulvodynia, which means an unexplained pain or discomfort in the vulvar area during intercourse. Some older women experience the pain constantly, but it could be related to other bodily issues.

“Sex should never be painful,” said physician Pebble Kranz, owner of Rochester Center for Sexual Wellness. “It is always an issue that should be investigated by a healthcare provider and sometimes it takes a long time to get to the root of these issues and to find a provider who is skilled in evaluating and treating sexual pain, but one shouldn’t lose hope.”

Sometimes pain during sex causes a vicious cycle of exacerbating the issue. As the woman experiences pain, she becomes more fearful of intercourse, according to Kranz. When the fear causes her body to tense up, the pain worsens. Libido can taper off.

“This is made worse because many women keep the problem hidden, even from their partners, and feel shame about it,” Kranz said.

She added that many care providers minimize women’s complaint and are not aware of sexual medicine as a specialty that includes physical and mental health.

Treating sexual pain can include medication, physical therapy for the pelvic floor, mental health, relationship counseling and education.

“It’s really important that these women get referred to physical therapists who have specific training in the pelvic floor,” Barnabei said. “It’s very different from shoulder or knee pain. Not a lot of physical therapists have that level of training.”

Kranz recommends a book by physicians Irwin Goldstein, Andrew Goldstein and Caroline Pukall, “When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain.”

“It is not only a great overview of the problem, but also helps women advocate for themselves within their relationships and with their medical providers,” Kranz said.

For further reading, “Sex Rx” by Lauren Streicher explores how decrease in estrogen levels can cause vaginal and vulvar thinning and dryness, among other reasons for sexual pain.

“[Decrease in estrogen levels] is the most common cause for sexual pain for women past menopause,” Streicher said in an interview with In Good Health. She is a physician who serves as assistant clinical professor at Northwestern University’s Feinberg School of Medicine in Chicago.

About half her patients experiencing sexual pain are younger women. More of those seem eager to seek treatment. Streicher said that many mature women don’t seek treatment because of stigma or belief that painful sex is a normal part of aging.

“Everything is fixable,” Streicher said. “That’s not what women are hearing from their doctors.”

For some, finding a good lubricant solves their problem. Personal lubricants include many formulations, so trying a few may be warranted. If the over-the-counter types don’t work, a doctor can prescribe medication to help.

Some could relate to trauma of the muscular-skeletal structures or the soft tissue. During pregnancy, the tissues receive more blood flow and can become more sensitive. During the last trimester, the uterus can sit so low that sex hurts.

After delivery and recuperation, moms may experience pain during intercourse for other reasons. Breast feeding women can experience tissue atrophy as they have high progesterone levels.

In only the most rare cases does a patient need surgery to resolve her sexual pain issues.

Streicher recommends that women experiencing painful intercourse seek help from an expert in sexual pain or a menopause expert.

“I’ve yet to have a woman with painful sex for whom I wasn’t able to alleviate the problem,” Streicher said. “Get yourself in the hands of someone who can help you. It may be a general gynecologist and maybe not.

“If someone says there’s no solution, don’t believe it. Or if they’re dismissive and says, ‘This is a normal part of menopause,’ or that it’s normal after cancer of is a part of diabetes, don’t believe it.”

Particularly since so many conditions can contribute to pain during intercourse, it’s important for physicians to take their time to fully evaluate the patient to determine the cause(s).