We need to talk about painful sex and what you can do about it

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  • Pain during sex is a common problem for women, especially those going through menopause. According to the American College of Obstetricians and Gynaecologists, as many as 75% of women will experience pain during sex at some point.

    Pain during sex is pain or discomfort in a woman’s labial, vaginal or pelvic areas during, or immediately following intercourse.

    How does painful sex manifest?

    • The most common symptom is pain on entry and is often described as sharp or burning.
    • The second most common symptom is deep pain
    • Other symptoms include feelings of muscle spasms, pelvic cramping or muscle tightness

    What causes pain?

    Vaginal dryness

    Dryness is the most common cause in menopausal and post-menopausal women but younger women can also experience it. During sexual arousal, glands at the entrance of the vagina produce fluids to assist intercourse. If you don’t produce enough fluid, this can lead to painful sex.

    Lack of lubrication can be caused by:

    • Lack of foreplay (if you you think this is the reason you are experiening painful sex, try experimenting with one of the best vibrators on the market – we recommend the Satisfyer pro 2, £35.67 from Amazon)
    • A reduction in oestrogen, particularly after menopause or childbirth.
    • Medications, including certain antidepressants, antihistamines, and birth control pills.

    Certain conditions can also cause pain during sex, these include:

    Pelvic floor dysfunction

    The pelvis floor muscles, the ones you tighten when you want to stop passing urine quickly, can become uncomfortably tight. This can lead to pelvic aches and pain on entry during sex.

    Vaginismus

    This is the involuntary spasm in the vaginal muscles and is a very common cause of painful sex.

    Vulvodynia

    This refers to chronic pain that affects a woman’s external sexual organ, the vulva, which includes the labia, clitoris and the vaginal opening. It can occur in just one spot or affect different areas from one time to the next. This can include burning, stinging, soreness, itching, rawness and pain during sex. Doctors aren’t sure what causes it, and there is no known cure but self-help methods combined with medical treatments can help ease discomfort.

    Infections

    Bacterial, yeast, or sexually transmitted infections can cause pain during sex and usually have symptoms such as discharge.

    Ovarian cysts

    These fluid-filled sacs on the ovaries often have no symptoms but when they rupture, they can cause pain and bleeding.

    Fibroids

    Fibroids are non-cancerous growths on the uterus which can cause heavy menstrual bleeding, pelvic pressure, pain and painful intercourse.

    Psychological Factors

    Stress, anxiety, depression, guilt, relationship problems and a history of sexual abuse can also cause pain during sex.

    What can you do about pain during sex?

    60% of women surveyed said they had never discussed their painful sex with their health care provider.

    The most important thing to do is find someone you can talk to and get to the root of the pain.

    You can speak to your GP, who will ask you about your history of pain during sex and may also give you a physical examination. ‘If the pain is due to vaginal dryness secondary to the menopause, your doctor may prescribe HRT, or if due to endometriosis in the pelvis, may refer you for potential surgery,’ says Dr Larisa Corda, a leading gynaecologist and fertility expert. If your doctor suspects you have one of the conditions listed above, the treatments will vary.

    Lubricants can also make a huge difference to those who experience pain during sex. ‘If you need one with oestrogen as a result of the menopause then your GP can prescribe this. Lubricants that don’t have oestrogen can be bought over the counter in any chemist and it is important to try a selection to find what is best for you,’ says Joanne Hobson, a GP specialising in women’s health. There are also female dryness treatments that aren’t lubricants available on prescription, which you can speak to you doctor about. They range from creams to suppositories and pills.

    ‘For pain caused by psychological factors such as stress or a history of sexual abuse, counselling is often vital for treatment and reviving the pleasure associated with sex,’ says Larisa.

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