Painful Sex During Pregnancy: When to Call Your OBGYN in Durham

Pregnancy changes every aspect of your life as your body and mind prepare for welcoming your baby. For thousands of patients, this also includes transformations in the bedroom, as sex and intimacy may be uncomfortable—or even painful.

But what causes painful sex during pregnancy, and how can one of our OBGYNS in Durham and Chapel Hill help you? We’ll explore the answers as well as let you know when it’s time to call the doctor.

“Having a baby is an exciting time in your life, and you may want to still remain intimate with your partner,” said Carey Jefferson, CNM. “As your body changes during pregnancy, sex may become uncomfortable or feel differently than it did before. This is one reason why we work closely with patients to help them face these challenges if they occur during pregnancy.”

In addition:

“Sometimes the pain during sex may be due to an underlying medical condition, while in other cases, merely changing to a different position can be helpful. Together, we’ll create a care plan that works for you,” Amy Dixon CNM said.

What Causes Painful Sex During Pregnancy?

Your body is undergoing a lot of changes, and these transformations are the main reasons behind painful sex during pregnancy. We’ve outlined a few of the most common causes below:

Hormonal Changes

The natural, normal hormonal changes you’re undergoing may cause a dry vagina, which can cause sex to be painful and uncomfortable.

Bladder Pressure

When you’re pregnant, there’s added pressure on your bladder, which makes you feel like you need to urinate more often. This can frequently cause sex to be uncomfortable or painful.

Sore Breasts

Hormonal changes can also make your breasts and nipples more sensitive and sorer than usual, and for many women, this contributes to painful sex during pregnancy.

Uncomfortable Positions

As your baby grows and your uterus expands, some of the sexual positions you previously enjoyed may not be comfortable, causing painful sex during pregnancy. Trying a different position can often help alleviate this issue.

Mild Cramping

Because an orgasm releases oxytocin, some women may experience mild cramping after sex. As long as these are mild and they resolve shortly after sex, they can be typically treated with rest. However, because cramping can be indicative of other problems, we encourage you to contact us if they are intense and particularly if they don’t go away after rest.

Bleeding

During pregnancy, the cervix undergoes changes that make it more sensitive to touch. It can bleed much easier during sex. This may not be painful, but it can cause patients to worry. If you have bleeding with sex, please let us know.

STDs or Sexually Transmitted Infections

An STD can have serious consequences for both you and your baby. If you have discovered that your partner has been diagnosed with an STD, avoid all types of sex—anal, oral and vaginal. Then, schedule an appointment with us as soon as possible so we can test you for infection and help safeguard the health of both you and your baby.

If you’re not in a monogamous relationship or if you have a new sexual partner during your pregnancy, we urge you to practice safe sex.

When to Call Your OBGYN in Durham or Chapel Hill

If, at any point, sex is so painful that you’re avoiding it, schedule an appointment with us. In addition, any intense cramping associated with sex should also be evaluated by one of our OBGYNs in Durham or Chapel Hill.

Usually, we can schedule an appointment within a week – or sooner if it is an emergent issue – and we’ll provide the undivided attention you need. There’s no need to be embarrassed to discuss sex with us: Intimacy with your partner is an important part of your overall well-being, and sexual health is an important aspect of your life.

Is Sex Safe During Pregnancy?

If you have a low-risk pregnancy with no complications, then typically there is no issue with sexual activity. If you have placenta previa or bleeding complicating your pregnancy, you should talk to us about the potential risks of intercourse during pregnancy.

See Why We’re Your Trusted OBGYNs in Durham and Chapel Hill

We understand.

You want the advantage of state-of-the-art care that you’d find at a major university hospital.

You also want the personalized, compassionate care that you’d receive at a smaller medical practice.

The good news is you don’t have to choose: With Chapel Hill OBGYN, you can have the best of both worlds.

For more than 40 years, we have treated generations of patients in the Triangle, Chapel Hill and Durham areas, welcoming new lives into the world and helping patients overcome health care challenges. We would welcome the opportunity to be your medical home, regardless of your stage in life.

Contact us to schedule an appointment today!

Of course, painful sex isn’t limited to pregnancy. You may be surprised to learn that discomfort during intercourse is surprisingly common. We’ll answer some of the main concerns around painful sex and offer practical and long-lasting solutions.

Why is Sex Painful for Women? How Can a Gynecologist Help?

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:

Vaginitis

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.

Vaginal Injuries

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.

Congenital Abnormalities

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.

Menopause

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.

Vaginismus

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:

• Fibroid Tumors: These noncancerous tumors may need to be treated by a procedure called a myomectomy.
• Endometriosis: This painful condition occurs when the uterine lining (endometrium) grows outside the uterus. Treatment may include hormonal treatments or excision surgery.
• Ectopic Pregnancy: 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:

• Burning
• Itching
• 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:

Water-based Moisturizers

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.

Estrogen Therapy

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 our patients 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. Issues and problems with your vagina can be contributors to painful sex.

Speak to one of our doctors if you have:

• Vaginal redness
• Itching
• 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.

We’re 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.

Returning to the subject of pregnancy and pain, many women have difficulty determining if they are experiencing labor or a series of cramps called Braxton Hicks, also known as “false labor.”

While we encourage you to always speak with one of our providers if you have questions or concerns over whether you are really in labor, we still want to provide this useful information to help you.

How Can I Tell The Difference Between Braxton Hicks and Active Labor Pains?

Imagine: you’re expecting a baby when you suddenly feel a sharp pain in your abdomen. Is this labor? Should you go to the hospital? Or is this Braxton Hicks, often referred to as “false labor”?

Although there are differences between Braxton Hicks and actual labor, it can often be difficult to tell them apart, which is why we always encourage our patients to call us if they aren’t sure.

“One of the most important things we want our patients to know is that there is a team of health care providers ready to answer any questions they have about Braxton Hicks or anything related to their pregnancy,” said Dr. Sonya Williams. “We’re also fortunate to have a knowledgeable, compassionate and helpful team of nurse midwives available for you.”

What Are Braxton Hicks Contractions?

These are irregular contractions of the uterus that may start in your fourth month of pregnancy. They are perfectly normal. Some describe it as a tight feeling in the abdominal area that comes and goes. Braxton Hicks contractions are your body’s way of preparing you for the act of labor. In fact, they may occur more often as you get closer to your due date.

What Is the Difference Between Braxton Hicks and Active Labor Pains?

Some differences include:

• Braxton Hicks contractions do not get closer together.
• Braxton Hicks contractions are irregular.
• Braxton Hicks contractions do not last as long as active labor pains. 
• Braxton Hicks contractions do not get more intense over time.
• Often, Braxton Hicks contractions can be alleviated when you change your position.
• Braxton Hicks contractions can often be alleviated with rest.

When In Doubt, Call Us!

Our first priority is helping you deliver a healthy child. “False alarms” are extremely common, and every labor experience is unique. Therefore, we encourage you to call us if you’re not sure if you’re in labor. If you have any questions about what to expect as you approach your due date, please let us know. Our doctors, nurses and wonderful midwives are here to serve you!

Chapel Hill OBGYN Offers Extensive Reproductive Services

We have treated generations of women, from those having their first gynecological exam to those entering menopause. For more than 40 years, we have been the provider of choice for extensive women’s health care. We have helped couples overcome the challenges of infertility and have delivered hundreds of healthy babies.  

See how we combine the expertise of larger research facilities with the personalized experience of smaller practices. Schedule an appointment today.