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When Sex is Painful- Happy Valentines Day?

This Valentine's Day, I thought we would talk about something that could help improve your V day with your partner and what we can do to help.

Pain during sexual intercourse is called dyspareunia. Pain that occurs during other sexual activities is called noncoital sexual pain disorder. Pain during intercourse is very common- nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem. Painful intercourse has MANY possible causes. Successful treatment depends on finding the right cause and sometimes trying different treatment options.

Painful sex can take a toll on a relationship

Gynecologic Problems

Pain during sexual intercourse can be a warning sign of many gynecologic conditions. Some of these conditions can lead to other problems if not treated.

Vulvar Pain

Vulvar pain can be classified as either acute or chronic. Acute pain usually goes away once the underlying condition is treated. Chronic pain lasts longer. Chronic pain also occurs in people in whom no underlying condition can be found.

Acute Vulvar Pain. A common cause of acute vulvar pain is a condition called contact dermatitis. This condition is a reaction to an irritating substance, such as perfumed soaps, vaginal sprays, douches, or lubricants. It may cause a rash, swelling, and redness. The most common symptoms are itching, burning, and pain. Treatment of contact dermatitis includes stopping the use of the irritating substance. Medications that are applied to the skin may be helpful. In severe cases, oral medication may be prescribed.

Other causes of acute vulvar pain include infections, skin disorders, and injuries. Infections can cause pain, itching, and irritation. Skin disorders may result in ulcers or cracks in the vulvar skin. Infections usually can be treated with medications. Treatment of skin disorders depends on the type of disorder. Some are autoimmune disorders that are treated with special types of medications.

Chronic Vulvar Pain.

Chronic vulvar pain that has no other cause is called vulvodynia. Almost 1 in 5 women may feel this kind of pain at some time. The pain often is described as burning, stinging, irritation, or rawness.

There are two types of vulvodynia: generalized vulvodynia and localized vulvodynia. In generalized vulvodynia, the pain occurs on a large area of the vulva. In localized vulvodynia, the pain is felt on a smaller area, such as the clitoris. With either type, pain may occur when the vulva is touched or when pressure is applied, or it may not have any relationship to touch or pressure.

When the pain is confined to the vestibule (the area around the opening of the vagina), it is called vulvar vestibulitis syndrome (VVS) or vestibulodynia. The pain occurs when the area is touched, when a tampon is used, during sex when the penis enters the vagina, during a pelvic exam, when sitting for a long time, or when tight clothes are worn. The area may become red and inflamed.

Some women with vulvodynia find relief with self-care measures. These can include wearing 100% cotton underwear, washing the vulva with water only, patting (not rubbing) the area dry after bathing, and using adequate lubrication during intercourse. If these measures do not work, treatments such as medication, relaxation exercises, and counseling can be tried. For severe cases that do not respond to other treatments, surgical treatment may be recommended.

Vaginal Pain

There are many causes of vaginal pain that occur because of sexual activity. It is important to find the right cause because treatment for each differs.

  • Hormonal Causes. During perimenopause and menopause, decreasing levels of estrogen may cause changes in sexual response such as slower lubrication, less vulvar swelling, or reduced length and width of the vagina. You also may have lower levels of estrogen if you have just had a baby or are breastfeeding. If you are perimenopausal or menopausal, your health care provider can prescribe local estrogen therapy (rings, creams, or vaginal tablets) to relieve vaginal dryness. Using a lubricant during sex or a vaginal moisturizer is helpful. Another option to improve lubrication is a longer period of foreplay. You also can try sexual activities that do not involve intercourse while you are waiting for treatments to work.

  • Vaginitis. Vaginitis, or inflammation of the vagina, can be caused by a yeast or bacterial infection. Symptoms are discharge and itching and burning of the vagina and vulva. Vaginitis can be treated with medication once the cause of the vaginitis is found.

  • Vaginismus. Vaginismus is a reflex contraction (tightening) of the muscles at the opening of your vagina. The tightened muscles make it difficult or impossible for your partner's penis to enter your vagina during sexual intercourse. Some women with vaginismus also have trouble inserting tampons or undergoing a pelvic exam. Vaginismus may cause pain, most often described as burning or stinging, when you try to have sexual intercourse. In some cases, sexual intercourse is not possible because the muscles tighten so much. Vaginismus can be treated with different forms of therapy. Physical therapy and relaxation exercises may help stop vaginal muscles from contracting. Another treatment is a form of physical therapy that uses vaginal dilators that gradually increase in size. Biofeedback is another option, as are medications.

Perineal Pain

Women who have had an episiotomy or tears in the perineum during childbirth may have pain during sex that may last for several months. Treatments include physical therapy, medications, or surgery.

Deep Pain

Pain felt deep inside the body during intercourse may be a warning sign of an internal problem. It can have many causes:

Pelvic inflammatory disease

Problems with the uterus


A pelvic mass (tumor)

Bowel or bladder disease

Scar tissue (adhesions)

Ovarian cysts

Vaginal surgery

A pelvic exam or ultrasound exam often gives clues about the causes of deep pain. Further evaluation, sometimes involving a procedure called a laparoscopy, may be needed.

What Can I Do?

If you have pain during sex, you should make an appointment with us. While you're waiting, here are some self-help measures you can try to relieve pain during sex. Some involve your partner, while others can be done by you alone.

Use a lubricant. There are many types of lubricants. Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.

Make time for sex. Set aside a time when neither you nor your partner is tired or anxious. Talk to your partner. Tell your partner where and when you feel pain, as well as what activities you find pleasurable.

Try sexual activities that do not cause pain. For example, if intercourse is painful, you and your partner may want to focus on oral sex or mutual masturbation.

Try nonsexual, but sensual, activities like massage.

Take pain-relieving steps before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse. To relieve burning after intercourse, apply ice or a frozen gel pack wrapped in a small towel to the vulva.

How Your Health Care Provider Can Help

See your health care provider if you frequently have pain during sexual intercourse or if pain is severe. Many causes of painful intercourse can be treated with medication, surgery, or other forms of therapy, such as trigger point injections. Make sure to bring all your questions to the appointment, and we will work together to find the cause and craft a treatment plan.

Yours in Vaginas,

Dr. Nicole E. Williams, MD, FACOG, FACS

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