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.”

Complete Article ↪HERE↩!

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Vaginismus: a major psychological reason women experience pain during sex

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If you have never heard of vaginismus, it’s time to get it on your radar.

Don’t suffer in silence

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[A]ly Dilks, sexual health expert and clinical director at The Women’s Health Clinic, says: ‘It is the term used to describe recurrent or persistent involuntary tightening of muscles around the vagina whenever penetration is attempted,’

According to Vaginismus Awareness, the condition affects at least two in every 1,000 women at some point in their lifetime.

Approximately 10% of adult women have experienced painful intercourse in the past six months.

‘It’s not fully understood why the condition happens [but] factors can include thinking the vagina is too small, negative sexual thoughts – thinking sex will be painful and cause damage – and previous sexual abuse,’ says Ms Dilks.

She also lists damage to the vagina – common during childbirth or an episiotomy, a painful first sexual experience, relationship problems, and fear of pregnancy as other potential triggers.

Pain is not limited to sex.

Some women find inserting tampons or fingers painful; others find any type of penetration intolerable.

Unlike other causes of vaginal pain, such as an infection, vaginismus is a psychological problem that cannot be cured with a straightforward prescription.

There’s effective treatment

Help is available beyond search engine suggestions

This is not to say it can’t be treated: Vaginismus Awareness reports a 95% chance of treating this psychological condition effectively, and many women receive referrals to a sex therapist as a first port of call.

Colin Richards is a relationship and sex mentor and the founder of Intimacy Matters.

He says: ‘As a practitioner who works with both the psychological and physiological, about 20% of female clients that come to me for treatment around sexual performance come with some level of vaginismus.

‘The psycho-sensual treatment I offer involves talking through the psychological influences, followed by sensual massage that is given in controlled, professional space.

‘It allows the new emotional tools to emerge in an authentic, non-judgemental way.’

Both Ms Dilks and Mr Richards also suggest vaginal trainers: four, smooth, plastic penis-shaped objects in different sizes.

They can be used in the privacy of your own home, at your own pace. Ms Dilks says: ‘Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on.’

‘It doesn’t matter how long it takes – whether it’s days, weeks, or months.’

Vaginismus is just one of many types of sexual frustrations and fears women face but, says Mr Richards, it is probably the most challenging for the sufferer.

That challenge is perpetuated by a lack of awareness and the taboo that still surrounds female sexuality, even when women talk to one another.

Yet it can have major implications on a woman’s sex life, self-esteem, body image and her relationships.

Hope for sufferers

Women can be reluctant to talk about their sex life, even with other women

If you have pain during sex, during your period, or if there’s anything that concerns you about your sexual health, don’t suffer in silence; women have been doing that for too long, and vaginismus is something for which there is a proven treatment.

Mr Richards says: ‘In my experience, if one can get to the root psychological cause of the anxiety or fear, then the vaginismus can be removed completely.

‘I have seen improvement over a period of three to six appointments.

‘As the mind learns that sexual penetration is not painful or wrong, and is, in fact, pleasurable, the body soon responds and lets go of the need to tense up.

‘[The woman] remains calm, and feels familiar with the situation, and so confident that everything should be fine.’

Complete Article HERE!

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How to Rethink Intimacy When ‘Regular’ Sex Hurts

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There’s no rule that says sex has to be penetrative.

By Breena Kerr

[W]hen sex hurts, women often feel alone—but they’re not. About 30 percent of women report pain during vaginal intercourse, according to a 2015 study in the Journal of Sexual Medicine which surveyed a subsample of 1,738 women and men ages 18 and older online.

Awareness of painful vaginal sex—sometimes lumped under the term Female Sexual Dysfunction (FSD)—has grown as more women talk about their experiences and more medical professionals start to listen.

Many conditions are associated with FSD, including vulvodynia (chronic vulva pain), vestibulodynia (chronic pain around the opening of the vagina), and vaginismus (cramping and tightness around the opening of the vagina). But they all have one thing in common: vaginal or vulval pain that can make penetrative sex anywhere from mildly uncomfortable to physically impossible. However, you can absolutely still have sex, which we’ll get to in a minute.

First and most important, if you are experiencing any type of genital pain, talk to your doctor.

There’s no reason to suffer in silence, even if it seems awkward or embarrassing or scary. Your gynecologist has heard it all and can help (or they can refer you to someone who can). The International Pelvic Pain Society has great resources for finding a licensed health care provider who specializes in genital pain.

“We don’t yet know why women get vestibulodynia or vulvodynia,” Kayna Cassard, M.A., M.F.T., a psychotherapist who specializes in vaginismus and other pelvic pain issues, tells SELF. “[There can be] many traumas, physical and psychological, that become internalized and add to vaginal pain. Women’s pain isn’t just ‘in their heads,’ ” Cassard says.

This kind of pain can affect anyone—regardless of sexual orientation or relationship status—but it can be particularly difficult for someone who mostly engages in penetrative sex with their partner. The important thing to remember is that you have options.

Sex does not have to revolve around penetration.

Hell, it doesn’t even need to include it. And for a lot of people, it doesn’t. Obviously, if P-in-V sex is what you and your partner are used to, it can be intimidating to consider redefining what sex means to you. But above all, sex should be pleasurable.

“The first thing to do is expand what ‘counts’ as sex,” sex educator and Girl Sex 101 author Allison Moon tells SELF. “Many people in heterosexual relationships consider only penis-in-vagina to count as sex, and everything else is some form of foreplay,” she says. But sex can include (or not include) whatever two consensual people decide on: oral sex, genital massage, mutual masturbation, whatever you’re into.

“If you only allow yourself one form of sex to count as the real deal, you may feel broken for enjoying, or preferring, other kinds of touch,” Moon says.

To minimize pain, give yourself time to prepare physically and mentally for sex.

That might sound like a lot of prep work, but it’s really about making sure you’re in the right mindset, that you’re relaxed, and that you’re giving your body time to warm up.

Heather S. Howard, Ph.D., a certified sexologist and founder of the Center for Sexual Health and Rehabilitation in San Francisco, publishes free guides that help women prepare physically and mentally for sex. She tells SELF that stretching and massaging, including massaging your vaginal muscles, is especially helpful for women with muscle tightness. (Too much stretching, though, is a bad idea for women with sensitive vaginal skin that’s prone to tearing.)

Starting with nonsexual touch is key, as Elizabeth Akincilar-Rummer, M.S.P.T., president and cofounder of the Pelvic Health and Rehabilitation Center in San Francisco, tells SELF. This puts the emphasis on relaxation so you don’t feel pressured to rush arousal.

Inserting a cool or warm stainless steel dilator (or a homemade version created with water and a popsicle mold) can also help reduce pain, Howard says. Women can tailor the size and shape to whatever is comfortable. If a wand or dilator is painful, however, a cool cloth or warm bath can feel soothing instead. Again, do what feels good to you and doesn’t cause pain.

Several studies have shown that arousal may increase your threshold for pain tolerance (not to mention it makes sex more enjoyable). So don’t skimp on whatever step is most arousing for you. That might mean some solo stimulation, playing sexy music, dressing up, reading an erotic story, watching porn, etc.

And of course, don’t forget lubrication. Lube is the first line of defense when sex hurts. Water-based lubricant is typically the safest for sensitive skin. It’s also the easiest to clean and won’t stain your clothes or sheets. Extra lubrication will make the vagina less prone to irritation, infections, and skin tears, according to Howard. But some people may also be irritated by the ingredients in lube, so if you need a recommendation, ask your gynecologist.

Now it’s time figure out what feels good.

Women with pain often know what feels bad. But Howard says it’s important for them to remember what feels good, too. “Lots of people aren’t asking, ‘What feels good?’ So I ask women to set what their pleasure scale is, along with their pain scale. I ask them to develop a tolerance for pleasure.”

To explore what feels good, partners can try an exercise where they rate touch. They set a timer for 5 or 10 minutes and ask their partner to touch them in different ways on different parts of their body. Sex partners can experiment with location, pressure, and touch type (using their fingertips, nails, breath, etc.) and change it up every 30 seconds. With every different touch, women should say a number from 0 to 10 that reflects how good the touch feels, with 10 being, “This feels amazing!” and 0 meaning, “I don’t like this particular kind of touch.” This allows women to feel a sense of ownership and control over the sensations, Howard says.

Another option is experimenting with different sensations. Think tickling, wax dripping, spanking, and flogging. Or if they prefer lighter touch, feathers, fingers, hair, or fabric on skin are good options. Some women with chronic pain may actually find it empowering to play with intense sensations (like hot wax) and eroticize them in a way that gives them control, according to Howard. But other women may need extremely light touch, she says, since chronic pain can lower some people’s general pain tolerance.

Masturbating together can also be an empowering way for you to show a partner how you like to be touched. And it can involve the entire body, not just genitals, Akincilar-Rummer says. It’s also a safe way for you to experience sexual play with a partner, when you aren’t quite ready to be touched by another person. For voyeurs and exhibitionists, it can be fun for one person to masturbate while the other person watches. Or, for a more intimate experience, partners can hold and kiss each other while they masturbate. It feels intimate while still allowing control over genital sensations.

If clitoral stimulation doesn’t hurt, feel free to just stick with that.

It’s worth noting that the majority of women need direct clitoral stimulation to reach orgasm, Maureen Whelihan, M.D., an ob/gyn in West Palm Beach, Florida, tells SELF. Stimulating the clit is often the most direct route to arousal and climax and requires no penetration.

Some women won’t be able to tolerate clitoral stimulation, especially if their pain is linked to the pudendal nerve, which can affect sensations in the clitoris, mons pubis, vulva, vagina, and labia, according to Howard and Akincilar-Rummer. For that reason, vibrators may be right for some women and wrong for others. “Many women with pelvic pain can irritate the pelvic nerve with vibrators,” says Akincilar-Rummer. “But if it’s their go-to, that’s usually fine. I just tell them to be cautious.”

For women with pain from a different source, like muscle tightness, vibrators may actually help them become less sensitive to pain. “Muscular pain can actually calm down with a vibrator,” Howard says. Sex and relationship coach Charlie Glickman, Ph.D., tells SELF that putting a vibrator in a pillow and straddling it may decrease the amount of direct vibration.

Above all else, remember that sexual play should be fun, pleasurable, and consensual—but it doesn’t need to be penetrative. There’s no need to do anything that makes you uncomfortable physically or emotionally or worsens your genital pain.

Complete Article HERE!

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Vaginismus: solutions to a painful sexual taboo

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Many women use terms such as ‘failure’ or ‘freak’ to describe themselves

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Vaginismus is often a problem from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences
Vaginismus is often a problem from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences

[V]aginismus is a very common but rarely discussed problem. Most women I see with this difficulty will not have discussed it with anyone else, not even female members of their own family or girlfriends. The silence that surrounds the issue and the sense of shame experienced sometimes serves to compound the difficulty itself. Many women with whom I have worked will use terms such as “failure” or “freak” to describe themselves, wishing they were “normal” just like every other woman.

Before seeking therapy, they will often have suffered this distress over a long period of time, not feeling able to embark on or enjoy sexual relationships. The thought that they may not be able to conceive through intercourse is frequently a huge anxiety for these women.

What is vaginismus?
Vaginismus occurs when the muscles around the entrance to the vagina involuntarily contract. It is an automatic, reflexive action; the woman is not intending or trying to tighten these muscles, in fact it is the very opposite of what she is hoping for. Often it is a problem right from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences. In most cases, the woman is unable to use tampons or have a smear test.

What are the symptoms?
The main symptom of vaginismus is difficulty achieving penetration during intercourse and the woman will experience varying degrees of pain or discomfort with attempts. Partners often describe it like “hitting a wall”. This is as a result of spasm within the very strong pelvic floor or pubococcygeus muscle group. Spasm or tightening may also occur in the lower back and thighs.

What are the causes?
Vaginismus is the result of the body and mind developing a conditioned response to the anticipation of pain. This is an unconscious action, akin to the reflexive action of blinking when something is about to hit our eye. This aspect of vaginismus is one of the most distressing for women as they really want their bodies to respond to arousal and yet find it impossible to manage penetrative sex. The more anxious they become, the less aroused they will feel and the entire problem becomes a vicious cycle.

Vaginismus can occur as a result of psychological or physical issues. Often it is a combination of both. Psychological issues centre around fear and anxiety; worries about sex, performance, negativity about sex from overly rigid family or school messages.

Inadequate sex education is often a feature in vaginismus, resulting in fears about the penis being able to fit or the risk of being hurt or torn. There can also be anxiety about the relationship, trust and commitment fears or a difficulty with being vulnerable or losing control.

Occasionally a woman may have experienced sexual assault, rape or sexual abuse and the trauma associated with these experiences may lead to huge fears around penetration. There are physical causes too – the discomfort caused by thrush, fissures, urinary tract infections, lichens sclerosis or eczema and the aftermath of a difficult vaginal delivery can all trigger the spasm in the PC muscles. Menopausal women can sometimes experience vaginismus as a result of hormonal-related vaginal dryness.

Treatment
Vaginismus is highly treatable. Because every woman is different, the duration of therapy will vary but, with commitment to the therapy process, improvement can be seen quite rapidly. Therapy is a combination of psychosexual education, slow and measured practice with finger insertion and/or vaginal trainers at home and pelvic floor exercises. Women with partners are encouraged to bring them along to sessions so that the therapist can work with them as a couple towards a successful attempt at intercourse.

Vaginismus can place huge stresses on a couple’s relationship as well as their sexual life; therapy can help the couple talk about and navigate these stresses. This is particularly important for a couple wishing to start a family.

What do I do if I think I have vaginismus?
Make an appointment with the GP. It will be helpful to have an examination to out rule any physical problem and have it treated if necessary. The GP is likely to refer you to a sex therapist, a psychotherapist who has specialised in sex and relationships through further training. They have specific expertise in working with this problem on a regular basis. You can also refer yourself to a sex therapist but, because of the very complex and sensitive nature of sex and sexuality, it is important to ensure that they are qualified and accredited. Sex therapists in Ireland may be found on www.cosrt.org.uk

GEMMA’S STORY
Robert was my first boyfriend. We waited six months to try sex, mostly because I was a virgin and very nervous. My mother had always warned me about not getting pregnant and I think I was too scared to try. When we did try, it didn’t work, it was disastrous. We tried again and again but he could not get in.

Every time we tried, I ended up in tears and over time I started to avoid sex. Robert was really patient but I know that it was very tough for him and I felt guilty. We thought it was a phase and it would improve with time. It didn’t stop us getting engaged because we knew we were right for each other.

Eventually I got the courage up to go to the doctor who diagnosed vaginismus – the relief of having a name to put on it was huge. She referred me to a sex therapist. I was embarrassed even talking about it, but quite honestly it was a relief to finally discuss it all. She explained everything about my problem and started me practising with vaginal trainers. I even got to start using tampons, something I never thought I would be able to do.

Robert also came to the sessions and that was a big help. We were given exercises to do at home together that helped me relax a lot. I made a lot of progress over a couple of months and, finally, last Christmas we got to try intercourse again. Success! Our sexual relationship is completely different now, no more worries and lots more fun.

I feel as if a huge worry has been lifted off my shoulders.

Complete Article HERE!

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