8 Things Doctors Wish You Knew About Dyspareunia, AKA Painful Sex

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Yup, we mean the bad kind of pain.

[P]op culture’s depictions of sex typically focus on the romantic, the salacious, and (in some refreshing cases) the embarrassing.

But one thing that’s still rarely mentioned—both on screen and IRL—is pain during sex (also known as dyspareunia), or the shame, confusion, and stigma that often accompany it. (And we’re not talking about the good, consensual kind of pain during sex, FYI, we’re talking about sex that hurts when you don’t intend it to.)

While dyspareunia may be absent from many sexual-health discussions, it’s not rare, and it’s certainly nothing to be ashamed of. Here, doctors walk us through what they wish more people knew about painful sex:

1. Unfortunately, pain during intercourse isn’t that rare. In fact, it’s really common.

Nearly 75 percent of women will experience pain during sex at some point in their lives, according to the American College of Obstetrics and Gynecologists (ACOG). Sometimes, this pain will be a one-time thing. Other times, it will be more persistent.

2. The thing is, sex isn’t supposed to hurt unless you want it to.

Some people accept painful sex as the norm, but it shouldn’t be. “The most crucial thing for women to know is that pain during or after intercourse is never really OK,” Antonio Pizarro, M.D., a Louisiana-based gynecologist specializing in pelvic medicine and reconstructive surgery, tells SELF. There are, of course, some circumstances in which someone might seek out some level of pain during sex. But there’s a difference between a sexual kink and undesired, severe, or persistent pain in the vulva, vagina, or pelvis.

3. Minor soreness during or after sex and intense, chronic pain are not the same thing.

There are tons of reasons you might be sore after sex, Natasha Chinn, M.D., a New Jersey-based gynecologist, tells SELF. They include inadequate lubrication, penetration with a particularly large object or body part, and sex that was especially rough or fast.

If these are minor issues you only encounter every now and then, Dr. Chinn says you can usually pinpoint the cause of the problem and address it on your own (use more lube, seek out smaller sex toys, or have slower, more gentle sex). (Of course, you can go straight to seeing a doctor if you prefer.)

But what if your problem isn’t an every-now-and-then thing? If these issues are happening every time you have sex, happening more frequently than they used to, or if they’re not going away after you try to address them on your own, your painful-sex cause might be more complicated.

4. Unfortunately, there are a ton of health conditions—like endometriosis, cervicitis, and vaginismus—that can lead to painful sex.

Some of these include:

  • Contact dermatitis: a fancy medical name for an allergic reaction on the skin—and yes, that includes the skin on your vulva. This can happen if, say, the delicate skin around your vagina doesn’t react well to a soap, body wash, or detergent you’re using. Contact dermatitis can leave your skin cracked and uncomfortable, and chances are that any kind of sex you’re having while you’re experiencing this reaction is going to be pretty painful.
  • Cervicitis: a condition where the cervix, or lower end of the uterus connecting to the vagina, becomes inflamed, typically due to a sexually transmitted infection. While it often presents without symptoms, Dr. Pizarro cautions that it sometimes causes pain during urination or intercourse.
  • Endometriosis: a condition associated with pelvic pain, painful periods, and pain during or after sex. While the exact cause of endometriosis is not well understood, it seems to be the result of endometrial tissue (or similar tissue that’s able to create its own estrogen) growing outside of the uterus, which can cause pain, scarring, and inflammation. This can lead to pain that’s sometimes worse around your period, when going to the bathroom, and even during sex.
  • Ovarian cysts: fluid-filled sacs found in or on the ovaries. Sometimes they don’t cause any symptoms, but other times they rupture, causing pain and bleeding, including during sex.
  • Pelvic inflammatory disease (PID): this condition is typically caused when bacteria from a sexually transmitted infection spreads to the reproductive organs. PID can cause pain in the abdomen or pelvis, pain during urination, pain during intercourse, and even infertility if left untreated.
  • Uterine fibroids: noncancerous growths in or on the uterus. Fibroids often don’t cause symptoms, but they can make themselves known via heavy menstrual bleeding and pelvic pressure or pain, during sex or otherwise.
  • Vaginismus: a condition that causes the muscles of the vagina to spasm and contract. This can lead to pain during sex—or even make any form of vaginal penetration impossible, whether it’s sexual or just inserting a tampon.
  • Vaginitis: an umbrella term for disorders that inflame the vaginal area. Examples include bacterial vaginosis and yeast infections, both of which occur when the balance of microorganisms in the vagina gets thrown off, causing some kind of bacterial or fungal overgrowth. Other forms of vaginitis are sexually transmitted infections such as trichomoniasis (an STI caused by a parasite), chlamydia, and gonorrhea. All three of these infections are characterized by changes in vaginal discharge, vaginal irritation, and, in some cases, pain during intercourse.
  • Vulvodynia: a condition charactized by chronic pain at the opening of the vagina. Common symptoms include burning, soreness, stinging, rawness, itching, and pain during sex, Dr. Chinn says, and it can be devastating. According to the Mayo Clinic, vulvodynia consists of pain that lasts for at least three months that has no other identifiable cause.

Dr. Chinn says that women going through menopause might also experience pain during sex as a result of vaginal dryness that happens due to low estrogen levels.

People who recently gave birth may also grapple with discomfort during sex, Dr. Chinn says. It takes time for the vagina to heal after pushing out a baby, and scar tissue could develop and make sex painful.

5. There are so many other things that can mess with your sexual response, making sex uncomfortable or legitimately painful.

Any negative emotions—like shame, stress, guilt, fear, whatever—can make it harder to relax during sex, turning arousal and vaginal lubrication into obstacles, according to ACOG.

Of course, the source of these negative emotions varies from individual to individual, Dr. Pizarro says. For some, it’s a matter of mental health. Feeling uncomfortable in your body or having relationship issues might also contribute.

In an unfair twist, taking care of yourself in some ways, like by using antidepressant medication, blood pressure drugs, allergy medications, or some birth control pills, can also cause trouble with lubrication that translates into painful sex.

6. You shouldn’t use painkillers or a numbing agent to try to get through painful sex.

This might seem like the best way to handle your pain, but Dr. Pizarro cautions against it. Your body has pain receptors for a reason, and by numbing them, you could end up subjecting your body to trauma (think: tiny tears or irritation) without realizing it—which can just leave you in more pain.

7. If you’re not ready to see a doctor yet, there are a few things you can try at home, first.

According to ACOG, a few DIY methods might mitigate your symptoms:

  • Use lube, especially if you feel like your problem is caused by vaginal dryness.
  • Apply an ice pack wrapped in a towel to your vulva to dull a burning sensation when needed.
  • Have an honest conversation with your partner about what’s hurting and how you’re feeling. Let them know what hurts, what feels good, and what you need from them right now—whether that’s a break from certain sex acts, more time to warm up before you have sex, or something else.
  • Try sex acts that don’t involve penetration, like mutual masturbation and oral sex, which may help you avoid some of the pain you typically experience.

It’s totally OK to experiment with these things, Dr. Pizarro says, especially if they help you associate sex with something positive. But these tactics cannot and should not replace professional care.

8. If you’re regularly experiencing painful sex, you should talk to a doctor.

It’s really up to you to decide when to see a doctor about painful sex. “It’s like a cold,” Dr. Pizarro says. “If you’ve got a little cough, you might be all right. But if you have a cough and fever that haven’t gone away after a few days, you might want to see a doctor.” When in doubt, mention your concerns to your care provider, especially if any of these sound familiar:

  • Sex has always been painful for you
  • Sex has always been painful but seems to be getting worse
  • Sex is usually pain-free but has recently started to hurt
  • You’re not sure whether or not what you’re experiencing is normal, but you’re curious to learn more about painful sex

When you see your doctor, they’ll likely ask questions about your medical history and conduct a pelvic exam and/or ultrasound. “It’s important for doctors to ask the right questions and for patients to voice concerns about things,” Dr. Pizarro says.

From there, your doctor should take a holistic approach to treatment to address the possible physical, emotional, and situational concerns. “You really have to look at the total person,” Dr. Chinn says. Treatment options for painful sex vary wildly since there are so many potential causes, but the point is that you have options. “Many people think that it’s acceptable to experience pain during intercourse,” Dr. Pizarro says. “Use your judgment, of course, but it probably isn’t acceptable. And it can probably be made better.”

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