How painful sex can plague women at any age

Washington – Your brain may be ready for sex. But what if your body refuses to cooperate? Women desiring intimacy with their partner sometimes experience pain instead of pleasure. Painful intercourse can happen even without other health issues – and it’s more common than you might think.

In a 2013 survey, one in five women reported vulvar pain or discomfort during sex in the previous 30 days, and about 30 percent of women in a similar 2012 survey reported pain during their most recent sexual contact. Sometimes the pain is brief. But in others, it’s persistent.

Painful sex, known medically as dyspareunia, can have a variety of causes. Most affect women of all ages, although some women experience its onset during or after menopause. A variety of conditions, including endometriosis and a thinning of the vaginal wall, can be to blame – and sometimes, the pain has no discernible cause.

The pain can range from the discomfort of vaginal dryness to painful pelvic contractions or burning vulvar pain during penetration. Physical causes range. A lack of arousal or low estrogen can cause vaginal dryness and soreness. 

Infections or inflammation can lead to painful contractions of the pelvic muscles or burning pain during penetration. Birth control pills have also been linked with vulvar pain and uncomfortable intercourse.

Endometriosis can be the culprit. The condition, which causes the cells that line the inside of the uterus to grow in other parts of the body, can cause bleeding, stabbing pain or cramping that can last for days after sex.

Other women experience vulvodynia: genital pain that burns, stings or throbs and makes sex uncomfortable or impossible. Although it’s correlated with past vaginal infections and pelvic floor weakness, the disease is still not well understood and there is no known cause. Treatments range from psychological interventions to pelvic floor therapy and vestibulectomy, a surgery that removes painful tissue along the vestibule, which surrounds the openings of the vagina and urethra.

A history of sexual trauma is also linked to painful intercourse, including genito-pelvic pain or penetration disorder. Previously known as vaginismus, the condition can involve painful vaginal spasms when something enters the vagina and is thought to be caused by a fear of penetration.

For many women, painful sex begins with menopause. During menopause, the ovaries produce less estrogen, the hormone that helps ensure vaginal lubrication and keep the lining of the vagina flexible and thick. Decreased estrogen can cause painful dryness, thin the vaginal walls and even shrink vaginal tissue. Those changes are known as vaginal atrophy. Vaginal estrogen therapy can help; so can vaginal moisturizers and the use of silicone-based lubricants during sex.

Painful intercourse can affect self-esteem, body image and relationships. But despite its prevalence and importance, says Leah Millheiser, its highly personal nature means it can go unspoken and untreated. Millheiser, a clinical assistant professor at Stanford University and director of the female sexual medicine program there, says social taboos can get in the way of diagnosis and treatment.

"Some people are just uncomfortable talking about that area," she says.

Women who experience uncomfortable sex may also feel uncomfortable bringing up their complaints during a routine appointment. Doctors can share that discomfort, or not think to ask about sexual health, Millheiser says.

The Washington Post

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