The Nu Guide: What to do when sex is painful?
Intimacy and sex, whether solo or partnered, penetrative or non penetrative, should be a pleasurable experience. If you experience more than transient or temporary discomfort or pain with intercourse it is important to get expert advice to prevent it becoming a longstanding issue, which can have numerous knock on consequences on pelvic floor nerves and muscles, functioning of the pelvic organs and impact on relationships and self esteem.
There are many reasons why women might find sex painful and it is a very common symptom that most will experience at some point in life. It is important to understand the underlying cause to seek appropriate treatment. You might want to refresh your understanding of vulvo-vaginal anatomy to help.
Some of the more common issues that can be experienced are:
Lack of lubrication: Natural lubrication may vary from week to week due to natural hormonal changes across your menstrual cycle, or depending on level of arousal. More chronic decreases in lubrication can be seen following childbirth or menopause due to low estrogen levels. Some medication - particularly hormone blockers, cancer treatments or even the combined oral contraceptive pill - can affect vaginal secretions. Using an oil-based lubricant like Nu Balm can help reduce friction and make sex more comfortable.
Vulvodynia: This is a chronic pain condition that affects the vulval region. In the majority of younger women it is localised to the skin just at the entrance to the vagina called the vestibule. In older women it may be more widespread involving the outer skin and labia. The exact cause of vulvodynnia is unknown although there may be a triggering event or events. It can be difficult to diagnose as the physical examination can be completely normal or result in subtle changes in the colour of the skin only. The symptoms commonly described include burning, stinging, throbbing or searing typically with sex, tampon use or pelvic examinations. The pain may last for hours or even days after genital touch.
Infections: Bacterial, yeast or viral infections in the vulva, vagina or pelvis can cause pain in the affected area which would usually be worse during attempts at intercourse. Common infections include candida (thrush), herpes virus, sexually transmitted infection or pelvic inflammatory disease. Best practice would be for your doctor or nurse to perform a pelvic examination and consider swab tests before prescribing any treatment for a suspected infection.
Endometriosis: In this condition which affects one in ten women, tissue similar to the endometrial lining occurs outside of the uterus. Depending on the extent and location of the lesions this can cause deeper pelvic pain with any penetrative vaginal activity. This may occur just at certain times of the month or may happen throughout your cycle. If you have longstanding symptoms the pelvic floor muscles around the vagina can become very activated and tight causing pain throughout the vagina.
This is by no means an exclusive list and if you are experiencing pain with sex it is important to talk to a health provider who you feel comfortable discussing it with. They can help you identify the underlying cause and develop a treatment plan to help alleviate symptoms. A referral to pelvic physio, gynaecologist, dermatologist or sexual health doctor might be required.
It is important to avoid repeatedly engaging in activities which are painful as this can further worsen symptoms by creating a pain/fear/avoidance cycle which further impacts libido and lubrication.
Remember you are not alone and seeking help is the first step to finding relief. Please feel free to email clinical@nubalm.co if you have any specific questions that we might be able to help you with.
