When it hurts to have sex. Identifying and solving the problem.
Women suffering pain during sex is a very common topic discussed during my patient sessions. It’s also the source for many tears and tissues. Think about it, if you experience pain every time you have sex how long does it take before you don’t ever want to get horizontal again? The literature says you can develop an aversion after one to three experiences doing something that hurts. With those numbers it’s a wonder the species survived.
When it come to vaginal pain, Vaginismus, Dyspareunia, Vulvodynia and perineal lesions are big words used to describe serious discomfort. If you or your partner are experiencing pain during any kind of sexual activity I encourage you to start exploring the reasons why. Your sexuality is part of you. Don’t give it up because you associate it with pain. Many of the treatments are really effective if you can get the right diagnosis.
Vaginismus is defined as “a condition where there is involuntary tightness of the vagina during attempted intercourse”. I say it is a painful spasm of the vaginal muscle because of stress, pelvic inflammation, or overall sexual anxiety. The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. The woman does not directly control or ‘will’ the tightness to occur; it is an involuntary pelvic response. She may not even have any awareness that the muscle response is causing the tightness or penetration problem.
In some cases vaginismus tightness may cause burning, pain, or stinging during intercourse. In other cases, penetration may be difficult or completely impossible. Vaginismus is the main cause of unconsummated relationships. That means trouble losing your virginity or having sex effectively for the first time with someone new. The tightness can be so restrictive that the opening to the vagina is closed off altogether and the man is unable to insert his penis. (This is the base of all the stories of people getting “stuck together”). The vagina locks down during a muscle spasm and getting in or out is a problem. The pain of vaginismus ends when the sexual attempts stop, and intercourse is halted.
Vaginismus is treated well through pelvic physiotherapy. Physiotherapists who work with or specialize in urinary tract and bowel problems also deal with extra-tight or spasming vaginal muscles. The pelvis physiotherapists I know are great and get fabulous results. Google the location of one near you. One of the tricks I use is homemade dilators. Forget the expensive ones that look like narrow penises and try whittling down a tapered candle until you can get it inside. Start with a birthday candle and work your way up. Wax is inert and won’t break off and cause an infection.
Dyspareunia simply put is “pain at intercourse”. The pain can be in the genital area or deep inside the pelvis. The pain is often described as sharp, burning or similar to menstrual cramps. It can have many causes such as infections, dryness, hymen remnants, lack of elasticity, vaginismus (see above), pressure on the cervix, or thinning of the vaginal wall among other things. You have to rule out organic or physical reasons by a trip to your doctor before calling in the sex therapist. I have a bunch of suggestions that really work but explore the issue of inflammation first. There is no one solution that fits all.
Vulvodynia (vul-vo-DIN-ee-uh) is chronic pain in the area around the opening of your vagina (vulva) for which there is no identifiable cause. The pain, burning or irritation associated with vulvodynia may make you so uncomfortable that sitting for long periods or having sex becomes unthinkable. The condition can go on for months or years. I sometimes call it undiagnosed vulva pain because it is often the diagnosis when the doctors aren’t sure what’s wrong.
Treatments for all three of these conditions can include:
Pelvic floor therapy.
Many of the women I see describe red, inflamed tissues and bulging ducts around the opening of the vagina. There are some great creams coupled with gentle saline water jet therapy (some of which can cause contractions) that offer at least temporary relief.
Finally, the last common type of vaginal pain (not that there aren’t some more obscure reasons you could be hurting) are perineal lesions. The perineum is the inch and a half of tissue between the bottom of the vagina and the anus. The bottom of the vagina is stretchy and thin. It is this piece of tissue that can be cut (called an episiotomy) during childbirth to allow more expansion for the baby to be delivered. For some women there can be chronic tearing and pulling on this skin. And it hurts. Creams (like polifax or arnica) help but with some women the build up of scar tissue encourages the tear to keep opening. Sometimes a small suture works to close the fistula (another word for the sore) if the problem is more mechanical (meaning it keeps happening during sexual activity). Many of the causes of lesions are related to other health problems so go see your doctor.
This was a long-winded blog that basically says that if sex hurts, don’t suffer in silence. No matter where you live you can find help. It’s your sexuality. Make it pleasant and pain free.