Painful Sex: Five Reasons Why Women Experience It and How to Get Help

1.     Pelvic floor dysfunction 

Stress affects more than your mind. It affects your body as well. The result can be anything from intestinal issues or headaches to pelvic floor dysfunction. When you’re stressed, you may be more prone to holding your breath, which can cause you to tighten your muscles and bear down on your pelvic floor. Long-term stress can cause your pelvic floor to stay contracted. The result is pain during penetration. 

Other causes of pelvic floor dysfunction are traumatic injuries to the pelvic area, pregnancy, overuse of pelvic muscles, or being overweight.

If your doctor diagnoses pelvic floor dysfunction, the most common way to treat it is by referring you to a physical therapist, who can provide biofeedback to help both strengthen your pelvic floor muscles and train them to relax. 

2.     Menopause or perimenopause

As women approach or reach menopause, their estrogen levels fall. These hormonal changes can cause thinning of the vaginal walls and vaginal dryness. Vaginal walls may become less elastic and more fragile, causing sex to hurt. The unfortunate consequence can be a domino effect. Sex is uncomfortable, so you won’t want to partake as often, which further contributes to a loss of tissue health and elasticity. 

There are both medical and non-medical treatments for menopause-related pain during sex, including engaging in more foreplay and using over-the-counter lubricants. Your doctor can prescribe a low dose of estrogen, either in the form of pills, cream, or a ring inserted into your vagina. The FDA also recently approved two non-hormonal medications to treat menopause-related dyspareunia.

3.     Pelvic organ prolapse 

Pelvic organ prolapse occurs when the muscles that support your pelvic organs – the bladder, uterus, small bowel, or rectum – become detached from their normal position and fall into the vagina, causing the out-of-place organs to make sexual penetration painful or uncomfortable. If your symptoms are severe enough to affect your quality of life, your doctor may recommend you have it repaired through surgery. 

4.     Infections 

Infections, either sexually transmitted or another type of condition, can cause vaginal irritation or changes, swelling, discharge, or blisters or sores, resulting in dyspareunia. Fortunately, your doctor should be able to easily diagnose and treat infections to restore your vaginal health.  

5.     Vulvodynia or vaginismus 

Both vulvodynia, pain on or around the vulva, or vaginismus, an involuntary contraction of the vagina, can make sexual penetration difficult or impossible. Vulvodynia can be caused by past vaginal infections, sensitive skin, hormonal changes, or pelvic floor weakness. Vaginismus can result from an anxiety disorder, a childbirth injury, prior surgery, or negative feelings about sex due to past trauma. The two disorders are treated similarly, either with physical therapy, counseling, topical therapy, or a combination. 

The bottom line is, you don’t have to tolerate painful sexual intercourse. Keep the lines of communication open with your partner and consult a qualified physician who can help you reclaim a healthy, pleasurable sex life. Visit our website for more information about our practice and to schedule an appointment with one of our specialists.