Studies show that as many as 27 percent of women experience pain during sex at some point in their life. The number could be higher, because some women feel uncomfortable honestly sharing their experience.
The first thing I want women to know is that pain during sex is not a made-up or imagined problem. This is an actual medical condition with many causes. Gynecologists are skilled at diagnosing these conditions and helping you prevent future pain.
Pain during sex can come from many sources. Things like infections or skin lesions can trigger inflammation and cause pain. Trauma or tearing from vaginal childbirth can cause women to experience residual pain as well.
Some sources of pain are anatomical. Your bladder and bowel touch the vagina, so inflammation in either of these areas can lead to pain. Deeper anatomical problems can include fibroids on the uterus, ovarian masses, or endometriosis. Endometriosis is when cells from the uterus lining are found outside of the uterus. Because this tissue still responds to hormones, a woman can experience bleeding on the outside of the uterus as she goes through her cycle, causing inflammation and pain.
One of the most common causes of painful sex is vaginal dryness that can occur due to taking certain medications or contraceptives, breastfeeding, or simply aging and experiencing menopause. When the vagina is dry, it becomes more susceptible to infections, such as bacterial vaginosis (caused by an imbalance in bacteria) or a yeast infection (caused by an overgrowth in a type of fungus).
Most of these sources of pain can either be seen or felt by a gynecologist during an exam and diagnosed to begin proper treatment.
Proper vaginal hygiene is so important to preventing infections. One of the main things I stress ― and that my patients are surprised to hear ― is the importance of wearing cotton underwear and not wearing underwear at night to help prevent infections. This goes along with avoiding tight-fitting clothing as much as possible.
I also advise against putting anything in the vagina, such as douching or using vaginal deodorizers. Plain water is the best, and expert-recommended, way to cleanse the vagina. I tell my patients not to use commercial cleansing products with chemicals or fragrances, no matter how they are advertised. Over time, these things can irritate the vagina and become a source of pain.
Some people ask me whether probiotics can help prevent recurrent vaginal infections. While they haven’t been found to make a direct difference, they are overall a good thing for you. A good diet is generally seen as another way to contribute to good vaginal health.
If pain during sex is due to vaginal dryness, I recommend using a water-based lubricant.
If a woman is experiencing any kind of pain during sex, I encourage her to make an appointment with a provider she trusts to figure out if it is something that is easily treatable or if it is a sign of something more serious. The vagina is complex and closely situated to other organs. Having pain during sex could signify a problem from somewhere else, which is why I recommend coming to a clinic for an evaluation.
I would specifically encourage women having pain during sex to seek out an OB/GYN, since we specialize in women’s health. In the eyes of your health insurance, this is not considered specialty care, so just find someone in your insurance network.When the source of pain isn’t obvious during my evaluation with a patient, I may refer them to pelvic floor physical therapy at the Institute for Athletic Medicine. Your pelvic floor is the muscles that support your bladder, uterus, vagina, and rectum. Pelvic floor physical therapists specialize in techniques to help women relieve pain or tension in this muscle group. If you are postpartum or have vulvodynia (a form of chronic pain of the vulva), you may find this type of physical therapy to be particularly beneficial.
When I meet with a woman, I start off wanting to understand her medical history, specifically how long she has experienced pain during sex and how often it happens. Then I ask about acts that cause pain, such as initial penetration, deep penetration, or general discomfort overall. We also talk about vaginal health, like dryness, discharge, and hygiene habits. Finally, I’ll ask about bladder or bowel issues, like constipation, and whether she experiences any abdominal pain.
After I listen, I’ll follow up with a physical exam, looking for obvious skin lesions or inflammation and feeling for any masses in the pelvis. I’ll also use an ultrasound if I need a better look at something.
If exams and ultrasounds don’t reveal the sources of pain, and I don’t think the patient would benefit from pelvic floor physical therapy, additional procedures or surgery may be necessary to determine if pelvic pain is caused by endometriosis. However, this is typically a last resort.