Understanding Pain During Sex: A Candid Consult

While none of us like to experience pain, one place it certainly doesn’t belong is in intercourse! There are many reasons why a woman could experience pain during sex, also known as dyspareunia, so this month, we’re sitting down with Dr. Daniel DiSabatino of West Essex OB/GYN to better understand common causes, as well as how pain during sex can be treated.

What exactly is Dyspareunia?

Dyspareunia is the medical term for pain in the pelvis or genital area during sexual intercourse. This type of pain is often recurring and can be sharp or intense. While dyspareunia can impact both men and women, it’s much more common in women – and usually very treatable. Not surprisingly, women don’t love to talk about their pain during sex, and because of that, it’s often more common than you think. It’s ok to bring up this topic with your healthcare provider. You don’t need to endure pain during sex.

What are some of the most common causes of this pain?

There are several common causes for pain during sex, and can be categorized as insertional (pain with insertion) or penetrative (pain on deeper penetration) – But here, let’s talk about penetrative pain during sex:

In a younger population, we can see what is called “high tone pelvic floor dysfunction.” This is a type of penetrative pain where the muscles in the vagina and pelvis become very tight, which then leads to specific “balls of tender muscle” or “trigger points” that are painful. It’s more common in women who have not yet had children, and while anyone could experience this, it tends to be more prevalent in women with other pain syndromes, such as vulvodynia (insertive pain), vaginismus (tightening of all the vaginal muscles), bladder pain syndrome, and fibromyalgia, etc. We’re not really sure why – but it’s an interesting correlation that has been observed.

Treatment for this issue involves pelvic floor physical therapy to help relax the specific muscles and “trigger points” in the pelvis. Relaxation techniques are important because it is the tension in your muscles that is causing this pain, and you need to be able to learn to relax those muscles to help break the pain cycle. Therapy can differ from woman to woman, but usually treatment starts with between 4-12 weeks of intra-vaginal myofascial physical therapy.

For women experiencing menopause, hormonal changes can be a HUGE contributing factor to pain during sex. In particular, a lack of estrogen can cause vaginal dryness due to irritation from the vagina’s skin not being as thick as it once was. For these women, I recommend a lubricant during intercourse – coconut oil is of course the most natural, but there are several over-the-counter options. In general, silicone-based lubricants tend to be better than water-based because they last much longer. Water-based lubricants will be absorbed by your body quicker, and you’ll need to use more of it in the long run.

In other cases, your OB/GYN can help you to replace your body’s lack of estrogen via vaginal estrogen – creams, suppositories, rings – that can be placed in your vagina to help re-build its lining, create a better pH environment, and promote a healthier mucosa (thus, limiting irritation).

I always thought pain during sex might mean an STD. Is this still a possible cause?

Yes, a sexually transmitted disease could be a culprit, but is a less common cause of dyspareunia. If you’re experiencing deeper pelvic pain, pain radiating to the abdomen, or swelling in the lymph nodes, this may indicate a sexually transmitted disease. Interestingly enough, the majority of women actually don’t often show symptoms of chlamydia or gonorrhea. More commonly, a benign infection such as yeast or bacterial vaginosis will be causing the pain as opposed to an STD.

There are so many potential causes for pain that it’s good to visit with your OB/GYN provider if you have any concerns.

I know my body well and can tell when irritation is just a yeast infection. Can I treat myself and move on?

It’s great to know your body well, but it’s also always good to see your provider if you are experiencing irritation, regardless of what you think is the cause. All vaginal infections, including yeast infections, need a visible exam, and most importantly, a vaginal culture to ensure the right treatment.

Conversely, a woman may think she doesn’t have a yeast infection because she’s looking out for discharge or smell – but you can absolutely still have a yeast infection without showing the trademark symptoms. Every woman is different, and that’s why it’s good to meet with your OB/GYN before making assumptions or self-treating. If you’re experiencing irritation or pain, give us a call. It’s what we’re here for!

If you are experiencing pain or irritation during sex, or anytime, call your Axia Women’s Health provider to seek a solution.