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Why Has Intercourse Become Painful After My Hysterectomy?

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An EmpowHER reader writes: In the months after my hysterectomy and removal of my ovaries, my vagina just stopped lubricating even when I felt sexually excited. So my husband and I went to the drug store and bought some non-prescription lubricant. That did help a bit but I still have pain when we try to start intercourse. The pain is right at the opening of my vagina. Lately, we’ve been avoiding sex altogether.

Your story is a common one. After a woman’s ovaries are removed, her estrogen levels are very low. Estrogen has many actions in a woman’s body including maintaining the cells in glands at the vaginal opening and in the lining of the vagina. When estrogen levels are normal, these cells produce lubricating secretions. The secretions protect the vagina and the tissue surrounding the vaginal opening from infection and irritation. Low estrogen levels lead to a decrease in production of these secretions.

A woman’s vagina may be lubricated but she may not know it, since there is no particular sensation involved. You only sense wetness if the fluid gets to the entry area where the skin can feel wetness. Sometimes a woman or her partner needs to insert one or two fingers into the vagina to bring the fluid to the vaginal entrance. If there doesn’t seem to be enough fluid, commercial products designed for the purpose (NOT petroleum jelly) or saliva can be used.

That may completely solve the problem of difficult and/or painful penetration, but often it does not solve it. As in your own case, pain and a sense of tightness may persist. Why? This can happen because a woman has experienced weeks or months of difficulty and discomfort at the time of penetration. She has developed a conditioned, automatic response to vaginal penetration. She’s become anxious, even fearful; her body reacts; the muscles around her vaginal opening contract. It’s as if the muscles are saying “ No, no, this is gonna hurt.”

The name for this involuntary tensing of vaginal muscles is vaginismus. If you look up a definition of vaginismus it may say that vaginismus makes intercourse impossible. That can happen, but more commonly, the muscle tension just narrows the opening, making penetration difficult and painful (a burning sensation). If this keeps happening over and over, the problem will just get worse, so rule #1 is that you must stop all attempts at penetration that are painful. Obviously, you’ll need to explain this to your husband. It’s fine to engage in other sexual activity as long as the two of you agree there will be no attempts at penetration until the vaginismus is solved.

By the way, we want to mention that vaginismus can occur even in women whose estrogen levels are normal if they have come to associate vaginal penetration with pain. And, when a woman comes to fear penetration by a penis, her fears may generalize to other forms of vaginal penetration, for example inserting a tampon or having a gynecologic exam.

It’s one thing to understand the cause of vaginismus and another to reverse it and restore normal, comfortable sex. As we said, the first step in curing vaginismus is stopping the pain. The next steps are a bit complicated and require a detailed set of instructions, which for you will include the use of a vaginal estrogen.

To learn more about how vaginismus affects relationships, read the second article in this series here: Vaginismus and the Couple

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EmpowHER Guest

Thank you for this article! We've seen more in the media lately about vaginismus, which is wonderful because it used to be a little known, term; even among OBGYNS it seemed. We appreciate your accurate information. Consider posting our article about vaginismus myths: http://www.paindownthere.com/blog/3-myths-about-vaginismus

May 16, 2016 - 3:02pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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