This editorial series, S-E-X, is brought to you by the Fort Worth Moms Blog and Andrea Palmer, MD FACOG with Fenom Women’s Care. Our friends at Texas Health Care Privia Medical Group North Texas sponsored and crafted this blog post for the S-E-X editorial series, and identified some possible causes of pain during sex. All 15 original articles from the S-E-X series can be found on our website.
OUCH! Sex is supposed to be an intimate, pleasurable experience. So what is a woman to do when sex becomes uncomfortable, unpleasant, or downright painful? Just grin and bear it? Hope and pray it gets better? Absolutely NOT!
First, clue your partner in on the situation, and then immediately call your gynecologist because you need to be evaluated ASAP. Be ready to be completely upfront and honest with your doctor and to answer specific questions like:
- Do you have pain upon entry, or is it a deep pain with penetration?
- What is the quality of the pain? Burning? Itching? Aching? Sharp?
- Is the pain only with certain sexual positions?
- Are there any other symptoms associated with your pain like vaginal discharge or odor?
- Do you have any significant gynecologic history like pelvic infections, STDs, fibroids, or endometriosis?
Here is a list of six possible causes of painful sex and practical treatments to get you and your sex life back on track.
Atrophy
This is a condition caused by a lack — or decrease in the amount — of estrogen in a woman’s body. This occurs naturally during perimenopause (late 30s and 40s) and menopause (which is when a woman goes 12 consecutive months without a period; on average, this occurs at age 51) but can also occur as a result of chemotherapy or radiation. Women in the postpartum season, especially those who breastfeed, also experience a decrease in their estrogen levels and can have particularly painful sexual intercourse, especially in the setting of a healing laceration or episiotomy. Women should wait at least six weeks to attempt intercourse after a vaginal delivery and only when their obstetrician has examined and cleared them to resume sexual activities.
Atrophy can be treated with vaginal estrogen which comes in the form of creams, tablets, or a long-acting ring formulation that releases estrogen locally over 90 days. Talk to your gynecologist to decide which formulation is best for you. Not all patients are good candidates for vaginal estrogen, so be sure to review your past medical history with your doctor.
Infection
When the outer genitalia (vulva), the vagina, or the cervix are inflamed and irritated, there can be pain with sex. Yeast infections are a common cause, as well as sexually-transmitted infections like chlamydia, gonorrhea, and trichomonas. Evaluation by your gynecologist and treatment with an anti-fungal or antibiotic will quickly get you feeling better.
Urinary Tract Disorders
A bladder infection (a.k.a. cystitis or urinary tract infection/UTI) can make sexual intercourse unbearable. Classic symptoms of a UTI include a burning, painful sensation when voiding, urgency, frequency of voiding, blood in the urine, or the sensation of incomplete emptying of the bladder. A urinalysis will quickly reveal if infection is present and treatment with an antibiotic is necessary.
Interstitial cystitis is a chronic urinary tract disorder that causes pelvic pain and can present with pain during sex. This is not an infection but rather a state of chronic inflammation of the bladder wall. Certain foods can trigger pain symptoms and the diagnosis can be made based on the patient’s history and confirmed with specialized bladder testing. Treatment is with diet modification and medications.
Endometriosis
The classic symptoms of endometriosis are painful periods, pain with sexual intercourse, and pain with defecation — although not all symptoms have to be present to make the diagnosis. Tissue similar to the lining inside the uterus (known as the endometrium), is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. It is most commonly found on the pelvic peritoneum, on the ovaries, in the recto-vaginal septum, on the bladder, and bowel. Diagnosis is made based on a patient’s symptoms and history, and sometimes surgery is done to confirm and treat. Treatment also includes hormonal management with birth control pills or other medications.
Ovarian Cyst
An ovarian cyst occurs every month when a woman is ovulating, or releasing an egg to be fertilized; however, sometimes these cysts can become larger and/or persist longer than usual and cause pain during sex (as well as other activities like exercise). A pelvic sonogram (typically done trans-vaginally) can make the diagnosis, and usually the best course of action is just watchful waiting for the cyst to resolve on its own. Occasionally, surgery is needed to remove or drain the cyst if it persists or causes the ovary to twist, putting its own blood supply at risk.
Vaginismus
This is the involuntary spasms of the vaginal muscles. Pain will not only be present with sexual intercourse, but also with insertion of a finger or tampon. Pelvic floor physical therapy in combination with cognitive behavior therapy or psychotherapy may be included in the treatment regimen. Botox injections are a promising new therapy for vaginismus.
If you experience pain during intercourse, it is important to tell your partner to stop immediately. Trying to conceal the pain will usually result in you unconsciously withdrawing, which may be perceived as rejection. In the long term, it may lead to withdrawal and stress on the relationship. It is better to be open and honest with your partner and your gynecologist so that you can have the most pleasurable and intimate sex life possible.
Dr. Jamie Lin Walker Erwin was raised in Fort Worth and is thrilled to be practicing medicine in her beloved hometown. A graduate of R.L. Paschal High School, followed by the University of Arkansas and the University of Texas Southwestern Medical Center, Dr. Erwin completed her obstetrics and gynecology residency at the University of Alabama Birmingham in 2012. She is a life member of Alpha Omega Alpha National Honor Medical Society and a member of the American College of Obstetricians and Gynecologists and the American Medical Association. She became board-certified in 2014. An accomplished athlete, Dr. Erwin was the 1998 Davey O’Brien High School Scholar Athlete award winner and in college; she was an NCAA Division 1 Track and Field All-American in the heptathlon. Dr. Erwin now enjoys spinning, yoga, and running along Trinity Trails with her dog, Lucy. Other interests include fishing on the Texas Gulf Coast, cooking, and spending time with family. Dr. Erwin has been married to her husband, Charlie, for almost 13 years and has two young children — Georgia (age seven) and Henry (age three). Dr. Erwin is part of Texas Health Care Privia Medical Group North Texas.
