Sex is supposed to be an enjoyable activity. However, for millions of women, pain during intercourse robs them of any pleasure.
Pain during sex is very common—an estimated 3 out of 4 women experience it at some point in their lives, according to the American College of Obstetricians and Gynecologists.
Painful sex (called dyspareunia) comes in several different forms: some women only have pain at penetration while others experience problems only during deep thrusting. In certain cases, pain occurs any time something enters the vagina, including a tampon.
If you are experiencing painful sex, our gynecologists can help you return to a rewarding and satisfying love life.
Why Does It Hurt During Sex?
These are some of the most common causes of painful sex and their treatments:
Conditions Involving the Vagina
There are several different conditions or injuries to the vaginal area that can be responsible for painful intercourse. These include:
This is a bacterial or yeast infection causing burning, discharge and itching. We can determine the source of the problem and prescribe appropriate medication. Please remember that an antibiotic will only be successful if the source of the problem is bacterial, and overuse of these medications can make it more difficult to treat these infections in the future.
These are most often related to childbirth, especially due to tears or an episiotomy, and they can affect the vulva as well. If you’ve recently had a baby and have experienced dyspareunia, you should wait a bit longer before continuing sexual activity.
Any structural issue present since birth can cause painful sex. Some women have a condition called vaginal agenesis, or a vagina that has not fully formed. Another abnormality is the development of an imperforate hymen, although this is a relatively rare condition.
During menopause, the vagina loses some of its elasticity and moisture. Treatments may include hormonal replacement therapy, the use of water-soluble lubricants, or extended foreplay. There are also other alternatives such as estrogen creams, rings or other medications.
This condition causes the vaginal muscles to spasm and contract. Not only does it make sex painful, but it can also cause problems when trying to insert a tampon or during a Pap test.
While vaginismus is relatively common, many women are embarrassed to talk to their doctor about their condition, so researchers believe that it affects more women than preliminary statistics demonstrate.
Both physical and psychological conditions can contribute to vaginismus, such as:
- Being a survivor of past sexual abuse
- Anxiety or fear of sex
- Being a survivor of sexual assault
- Negative emotions toward sexual activity
We customize each treatment to best serve our patients and their individual needs. In general, treatment may involve:
- Kegel exercises
- Vaginal dilators
- Anesthetic creams that can be used temporarily
Survivors of sexual abuse may benefit from seeing a counselor who specializes in treating the psychological affects that result from being violated.
Conditions Involving the Uterus
When there are abnormalities in the uterus, sex can become uncomfortable or very painful. These conditions include:
These noncancerous tumors may need to be treated by a procedure called a myomectomy.
This painful condition occurs when the uterine lining (endometrium) grows outside the uterus. Treatment may include hormonal treatments or excision surgery.
An ectopic pregnancy is when the fertilized egg implants and grows outside of the uterus. This may be treated with medications or surgery.
What Are Other Causes of Painful Sex?
Other causes of painful sex include:
- Cervical infections
- Sexually transmitted illnesses
- Pelvic inflammatory disease
- Genital skin disorders
- Ovarian cysts
Can Vaginal Atrophy Cause Painful Sex?
Yes, it can. We’ll take a look at this condition, how to determine if you have it, and some possible solutions for painful intercourse.
What is Vaginal Atrophy?
Estrogen helps keep your vaginal tissues healthy. When your estrogen levels drop, it changes the way your vagina works.
Atrophy occurs over time as your vaginal lining begins to shrink and thin. Your vagina isn’t able to stretch as it once did, and the vaginal wall may also shorten and become narrower.
Vaginal atrophy is usually diagnosed by reviewing your symptoms and evaluating the results of a pelvic exam.
“Vaginal atrophy is most commonly seen in post-menopausal women, but those who are breastfeeding and have just had a baby may have issues due to a drop in estrogen levels,” said Dr. Sonya Williams.
“Vaginal atrophy can also occur if you’ve had your ovaries removed or if you’re taking certain medications for breast cancer treatment or endometriosis.”
When most women hear of vaginal atrophy, they think of something that occurs after menopause. However, it can occur in younger women when there is a reduction in estrogen levels.
How Does Vaginal Atrophy Cause Painful Sex?
Vaginal atrophy can cause painful intercourse because the thinner vaginal lining can contribute to vaginal dryness. In addition, it becomes more difficult for your vagina to stretch, and the vaginal wall narrows. This can make penetration difficult or even painful.
What Are the Symptoms of Vaginal Atrophy?
Vaginal dryness is one of several symptoms of vaginal atrophy. Others include:
- Vaginal discharge
- Spotting or bleeding
- Light bleeding after sex
If intercourse is uncomfortable for you, we encourage you to contact us for an appointment.
Can Vaginal Atrophy Cause Other Complications?
Yes. Atrophy doesn’t just affect your vagina. It can cause problems when you go to the bathroom, leading to frequent urinary tract infections (UTIs). You might also have to go to the bathroom more often and have pain when you urinate.
Those with atrophy are also more likely to have vaginal inflammation.
How is Vaginal Atrophy Treated?
Until your estrogen levels return to a normal level, you’re likely to have the symptoms of vaginal atrophy.
There are different types of treatment; some concentrate on alleviating the symptoms of vaginal atrophy, while others raise your estrogen level to restore your vagina to its healthier state. Following are some of the most effective methods of dealing with vaginal atrophy:
Relieving symptoms can be as straightforward as using a vaginal moisturizer.
Water-based ones can help restore the vaginal pH. Some can even last from three to four days, which is helpful to those who have a chronically dry vagina.
You can also help alleviate painful sex by using a water-soluble vaginal lubricant.
In any form, low-dose vaginal estrogen can help by:
- Restoring the vaginal pH
- Increasing vaginal secretions
- Thickening vaginal tissue
Estrogen can be applied via a skin patch or a pill, but often, it’s most effective to apply it directly to the vagina in the form of a cream. There are also silicone rings or estrogen-containing tablets that are placed in the vagina that release a steady, low dose of estrogen.
We recognize that no single form of estrogen therapy works for everyone. We’ll look at your individual case and examine your symptoms, your lifestyle and your medical history to determine what would work best for you.
Vaginal Bleeding After Menopause is Not Normal
If you are experiencing bleeding after menopause, it’s important to schedule an appointment with us.
While this can be caused by vaginal atrophy, it can also be seen in many other conditions. Most of these are not life-threatening. However, bleeding after menopause can be an indicator of certain cancers.
What Are Other Causes of Painful Intercourse?
Every case of dyspareunia is different. For some women, vaginal injuries, usually due to tearing during childbirth, can cause problems. Others may have a congenital condition called vaginal agenesis, which means the vagina has not fully formed.
We don’t want anyone to feel embarrassed to talk to us about their health care problems, whether it’s painful intercourse or vaginal discharge. We became OBGYNs to help women live the healthiest life possible, and this includes your sexual health.
We are partners in your care. We encourage you to ask questions at your annual exam or any appointment you have with us.
Sex Doesn’t Have to Be Painful
At Chapel Hill OBGYN, we want to assure our patients that they can – and should — speak to us about any medical condition or problems with their sexual health, no matter how “embarrassing” it may seem. As your health care providers, we are partners in your care, and want you to be healthy and have a rewarding sex life.
A pleasurable, healthy sex life creates a bond between you and your partner. There are several potential causes of painful sex, and they are treatable. Please speak with us if you have experienced pain during sex so we may listen to your concerns and discuss your treatment options.
Your Vagina: What’s Normal, What’s Not
It’s important to let us know if you have any change in the amount of vaginal discharge, or if it has a different color or odor. This could be an indicator of an infection.
Speak to one of our doctors if you have:
- Vaginal redness
- Vaginal pain
- A mass in your vagina
- Painful intercourse
- Urine leakage during coughing or sneezing
How to Keep Your Vagina Healthy
Your sexual health is an important aspect of your overall health. We’ve compiled a list of ways you can minimize your chances of getting a vaginal infection.
Practice Safe Sex
You should also be tested for sexually transmitted infections. Please be open and honest with us about your sex life, including the number of sexual partners you may have had. Our main interest is in safeguarding your health.
Have a Regular Exam
During these wellness visits, we’ll not only conduct a pelvic exam, but we’ll also speak to you about any other health concerns you have, whether it’s high blood pressure, diabetes or depression.
Understand Your Medications
Some of them may have side effects that could affect your vagina, such as making you more susceptible to yeast infections.
Perform Kegel Exercises
These exercises help tone your pelvic floor muscles and can be very useful, especially if you’ve experienced urine leakage.
Ready to Help You Through All Stages of Life
We’ve cared for mothers, daughters, and women of all ages. Through a highly personalized approach to medicine, we evaluate the most effective treatments to provide a medical plan tailored for your needs.
For many medical practices, those are just words. But for us, it’s a philosophy.
We love caring for our patients. We take time to learn their names and discuss their needs. We provide emotional and medical support for them no matter what age. Schedule an appointment to discover what makes us different.
For more than 40 years, Chapel Hill OBGYN has served patients in the Triangle area, sharing the joy of little miracles and supporting them during challenges. Our board-certified physicians and certified nurse midwives bring together the personal experience and convenience of a private practice with the state-of-the-art resources found at larger organizations. To schedule an appointment, please contact us for more information.