Is Sex Painful? Here are Some Reasons Why, and What You Can Do about It.

Dyspareunia, or painful intercourse, can occur at any age. The reasons for it, however, can vary depending on your life stage. In this article I will discuss some possible reasons for pain with sex throughout the lifespan.

➡️Young adulthood is an exciting time when many of us are first introduced to sex. Why is it sometimes painful? Some of the more common reasons are:

1. Vaginal dryness. The skin of the inner vulva and vagina are mucous membranes, which are naturally lubricated. This lubrication usually increases with arousal in preparation for intercourse. In some women who take hormonal birth control, however, the decreased levels of estrogen and testosterone interfere with lubrication, resulting in vaginal dryness, irritation and pain with sex.

2. Vaginismus, which is defined as an involuntary spasming of the pelvic floor muscles that makes vaginal penetration difficult or impossible. Vaginismus itself can have several causes, but the result is a cycle of pain-fear-spasm-pain that causes significant distress.

3. Anatomical variations: we’re all made just a little bit differently. Some of us with vaginas may have a more robust hymen, which can cause pain when it is stretched, or a retroverted uterus, which can cause deep pain when the penis or toy pushes against it.

4. Infections, such as bladder, yeast or sexually transmitted infections

5. Medical conditions, like endometriosis, IBS, adenomyosis, interstitial cystitis/painful bladder syndrome

6. Skin conditions, like lichen sclerosus, or ulcers from Crohn’s disease.

While talking about painful intercourse may stir up unwelcome feelings, it is important to understand that this is not normal and needs to be addressed, to prevent a cycle of pain from affecting your future sex life.

➡️Here's an interesting statistic: Up to 20% of women have pain with sex 6-12 months postpartum. Why is painful sex so common after childbirth? Some specific reasons for dyspareunia postpartum are:

1. Perineal trauma: vaginal birth can cause tearing and trauma to the perineum, including the pelvic floor muscles, resulting in scarring. These scars can restrict the ability of the vagina to stretch, resulting in pain.

2. Vaginal atrophy: estrogen remains low up to 6 months after birth, even longer for some breastfeeding moms. The vagina LOVES estrogen, so the lack of it can reduce vaginal tissue thickness, elasticity and lubrication, which can create irritation during intercourse.

3. Decreased libido: While this can also be attributed to hormones, the honest truth is that it is TIRING being a new mom. Lack of sleep, constant demands for feeding and other baby care, concerns about body image, and the general discomforts of being newly postpartum can combine to eliminate the desire for sex, so that when intercourse does happen (often out of a sense of obligation), it can hurt.

4. Other psychological factors: postpartum stress, anxiety, depression, and lack of social support can also contribute to painful intercourse because of the importance of the brain for arousal. In addition, stress can cause the pelvic floor muscles to tighten.

Painful sex can be easy to ignore in the postpartum period because you are already dealing with so much, but again, it is not normal, and should be discussed with your medical provider.

➡️Finally, let’s review some specific reasons for painful intercourse after menopause:

1. Vaginal atrophy: Estrogen is vital for the health of the vulvar and vaginal tissue; it promotes elasticity and thickness, as well as lubrication. When estrogen levels decrease after menopause, vulvar tissue gets thinner and droopier, it is less pliable, and it is drier. The vaginal canal itself can also narrow and shorten. Finally, changes occur to the blood vessels that can affect blood flow during arousal.

2. Stress: aging brings with it its own unique stresses, including but not limited to navigating declining health in yourself or your partner, caregiving for aging parents, and assisting adult children. Stress can interfere with the sexual response, contributing to painful intercourse.

Of course, painful sex after menopause may also be due to issues described previously. Consider this: If postmenopausal dyspareunia were due solely to decreased estrogen, wouldn’t ALL postmenopausal women have pain with intercourse? They don’t.

To sum up, pain with sex should NEVER be ignored, at ANY life stage. The more you know, the better you can advocate for yourself. And there is help! Let's check out a few simple ways you can begin to investigate what may work for you.

💦USE LUBE! Often the answer can be found by increasing vaginal lubrication, which decreases friction and subsequent irritation. There are lots of lubricant choices, so some general advice is to pick one with minimal additives to minimize changes to the vaginal environment.

👩‍⚕️See your doctor: he or she will do a physical examination and lab testing to check for any underlying anatomical or medical causes.

💤Prioritize sleep/rest, stress management, and diet: I know, easier said than done, but stress and fatigue can amplify both the pain and the resulting cycle that can result in the pain persisting. Inflammation from food allergies and sensitivities can also affect your vaginal tissue, causing irritation.

🧘‍♀️Stretch your hips and low back: pain can cause muscles to tighten, and tight muscles can cause pain. Regularly stretching your hips and back can help reduce this tightness. Plus, it feels good!

💦Consider vaginal moisturizer: moisturizer can be used daily to help hydrate and protect post-menopausal vaginal and vulvar tissue.

🏃‍♀️See a pelvic floor therapist! We can help you with strategies to desensitize and lengthen tight tissues, mobilize restricted perineal scars, calm the nervous system, and build awareness of and connection with your pelvic floor, to facilitate a return to sex without pain.

If you would like to learn more about how pelvic floor therapy can help you, send me a message and I will be happy to discuss any questions you might have. Here's to pain-free sex!

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