As the all-female rap group Salt-N-Pepa said, “Everybody has sex. I mean, everybody should be makin’ love.” But there comes a point for some women where the “Ahhh!” turns to “Ouch!”
While it is true that if you don’t use it you lose it, and that women who don't bring regular stimulation to the cells of their vagina find themselves having more painful intercourse, there are other top reasons that sex can hurt.
1) You are dry down there.
Whether it is dehydration, lack of estrogen, menopause, stress, lack of stimulation, clomid, or cervical surgery -- dryness causes a lot of pain. Make sure you are well hydrated with water, and get your hormone levels checked. Communicate with your partner about what turns you on, and use lubrication as needed.
2) You have an infection.
The vagina is its own little ecosystem. When a bacteria or yeast enters the domain your immune system reacts with itching, burning, odor, and/or discharge. Subsequent intercourse can be painful, leading to a worsening infection.
Not all itching or discharge is yeast though. If the over-the-counter products don’t work, see your health care provider right away. Better yet, see them first and get tested so that you don't waste time or prolong the pain.
3) You have endometriosis.
This is a condition where tissue from the uterus implants itself in other locations such as the vagina and abdominal cavity. It is sensitive tissue that often adheres to muscles, tendons and organs in a disorganized fashion making sex, particularly deep penetration, painful.
Endometriosis is not commonly seen on ultrasound and is typically diagnosed based on history and exploratory surgery to seek and remove the implanted tissue. Talk with your health care provider about diagnosis and your options.
4) You have lichen sclerosus.
This skin condition typically affects menopausal women around their labia and clitoris. The most common symptoms are itching in absence of an infection, as well as thinning and scarring of the skin resulting in fissures and narrowing of the vaginal opening if it progresses. Unfortunately this condition is not reversible, however there may be options to slow it down.
5) You have vulvodynia.
Vulvodynia is a condition where a woman has ongoing pain at the opening of their vagina that regular medical treatments do not resolve. Pain can interfere with intercourse, wearing jeans, using a tampon and even sitting.
A recent study at University of Michigan “found that more than 25 percent of women have experienced ongoing vulvar pain at some point in their lives.” Talk to your doctor if these symptoms sound familiar, or contact the NVA (see below) to find one.
6) You have a history of abuse.
This is a delicate topic, but an important one, to discuss. Muscles have memory and those muscles in and around the vaginal area may have been traumatized from an abuse history. This can still be true for women who are in the most wonderful of relationships now.
There are a variety of help options available including various counseling methods (it’s not one-size-fits-all) and pelvic floor physical therapy by qualified physical therapists.
Pain with sexual intercourse is not uncommon as most all women have experienced it every once in a while. Even something as simple as a position change or timing in the cycle can make a difference. If you are experiencing pain routinely, talk with your health care provider about an appropriate work up so that you do not have to suffer any longer.
Reources:
Endometriosis.org http://endometriosis.org
NVA (National Vulvodynia Association)
http://www.nva.org/whatIsVulvodynia.html
RAINN (Rape Abuse Incest National Network)
http://www.rainn.org
References:
1) Stewart, E. (2013). Lichen sclerosus (Beyond the Basics). Web. 22 February, 2014. Retrieved from
http://www.uptodate.com/contents/lichen-sclerosus-beyond-the-basics
2) Evangelista, A., Dantas, T., Zendron, C., Soares, T., Vaz, G., and Oliveira, M. (2014). Sexual Function in Patients with Deep Infiltrating Endometriosis. Web. 22 February, 2014. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/24165172
3) Chronic vulvar pain a reality for more than 100,000 women in southeast Michigan. University of Michigan Health.org. Web Feb. 25, 2014.
http://www.uofmhealth.org/news/se-michigan-vulvodynia
Reviewed February 25, 2014
by Michele Blacksberg RN
Edited by Jody Smith