What Are the Causes of Sex-Related Pain, and What Are the Treatments?

It’s date night, you’re in a good mood, and everything is going swimmingly. However, as you and your spouse begin to get intimate, you will experience pains, cramps, and even searing agony. What is going on?

While it is not often discussed, pain during sex is common: Almost three out of every four women will suffer pain during sex, a condition known as dyspareunia, at some time in their life.

Women suffer this discomfort for a variety of causes, ranging from a lack of lubrication to bigger reproductive system problems.

“When a woman presents with acute pain during sex, we have an opportunity to rule out treatable causes of the pain,” explains Dr. Anna Kirby, a board-certified obstetrician gynecologist who sees patients at the Pelvic Health Center at East Side Specialty Center and the Pelvic Health Center at UW Medical Center – Montlake

To help you understand any itching, burning, or soreness you may have during sex, Kirby discusses common causes and conditions that may contribute to your pain – and how to manage them.

Infections and excruciating sex

Because infections are often the cause of discomfort during sex and are readily treated with medicine, it’s better to rule out an infection first and then rule out other possible causes of pain, Kirby adds.

Depending on the kind of infection, yeast infections, urinary tract infections (UTIs), and sexually transmitted infections (STIs) may cause itching and burning during sex, inflammation, an odd odor, and a gray or creamy discharge.

What Are the Causes of Sex-Related Pain, and What Are the Treatments?

However, just because you smell something fishy does not mean you should self-diagnose and rush to the pharmacy for antibiotics.

“Many people are treated empirically for bladder and vaginal infections without undergoing a thorough assessment,” Kirby adds. “My worry is that kids are receiving an excessive number of unneeded or inappropriate antibiotics and therapies.”

This is troublesome since these symptoms are not always caused by common vaginal infections, and if the discomfort continues, it may result in pelvic muscle spasms, sensitive nerves, and irritated skin, all of which can result in persistent pain during sex even when no infection is present.

Additionally, it’s important to see your doctor often to ensure you get treatment for more severe infections such as pelvic inflammatory disease (PID), which may result in scarring and infertility if left untreated.

Factors associated with menopause and unpleasant sex

Hormones are another frequent source of sex-related discomfort in women, both before and after menopause.

Reduced estrogen levels in postmenopausal women may result in vaginal dryness or atrophic vaginitis, a weakening of the vaginal lining. Atrophic vaginitis may cause pain during penetration, itching or burning, and mild bleeding after intercourse.

While less frequent, younger women who have used birth control tablets in the past may also suffer vaginal lining thinning.

“For a tiny number of women who take the pill, it causes the lining of their vagina to get thinner, as it would after menopause, despite the fact that they are young and have a normal level of estrogen in their bodies,” Kirby explains.

Whether you’re suffering dryness or a weakening of the vaginal lining, she adds that a topical vaginal estrogen may aid in lubrication and reduce friction or discomfort. Other topical hormones, such as testosterone and androgens, may also be beneficial for younger women.

Muscular variables and sex-related entrance pain

If your discomfort is most severe during deep penetration — particularly if it occurs in non-sexual situations, such as when you use a tampon — it may be caused by pelvic muscle spasms, also known as vaginismus or pelvic floor spasms.

“When pelvic muscles contract and are unable to relax, symptoms comparable to vaginal infections may occur, as well as discomfort associated with vaginal penetration,” Kirby explains.

These muscular spasms may cause severe cramping or stabbing pain during sex, and they may also give the impression that your partner is encountering resistance during penetration.

Working with a pelvic floor physical therapist is the most effective method to alleviate muscular spasms and relax your pelvic floor.

If you continue to have pain, your doctor may inject an anti-inflammatory into the muscles to make them less sensitive or use Botox to temporarily and partly paralyze the muscles.

Factors anatomical and intense pain during sex

If your discomfort persists outside of sexual interactions and seems to be linked to your menstrual cycle, Kirby adds, it may be caused by endometriosis.

Endometriosis is a condition in which the tissue that normally lines the uterus begins to develop outside of the uterus, most often on other pelvic organs. This tissue subsequently degrades, resulting in severe, chronic pain in the back, pelvis, and abdomen.

What is the good news? Treatments such as medication, hormone therapy, and surgery are offered to assist alleviate pain.

On the other hand, if your discomfort occurs abruptly and severely during sex, it may be the result of a different physical factor: ovarian cysts, or fluid-filled sacs on your ovaries.

While many women have ovarian cysts, about 8% of premenopausal women experience painful cysts that need treatment. And in a few few unfortunate cases, these cysts burst.

If you suffer severe, unexpected pain, get urgent medical attention.

While the majority of ovarian cysts resolve on their own, your doctor may prescribe birth control tablets to help prevent the development of new cysts, and they can be surgically removed if they burst or cause other problems.

Finally, if your pain is focused in your vulva, you may develop vulvodynia, which is a persistent discomfort in your vulva and vaginal entrance.

“Always begin with a physical examination,” Kirby advises. “A variety of therapies, such as steroids and hormones, are beneficial.”

Another method of relieving irritation and any external rubbing discomfort is to apply a topical anesthetic, such as lidocaine, to the region where your vulva meets your vagina. For some women, using this topical anesthetic before to intercourse is beneficial.

Emotional elements and sex that is painful

Along with physical elements, emotional and psychological variables may contribute to sexual discomfort – even when the setting is healthy and consenting.

“If you do not have a supportive spouse, if you have a history of abuse, or if there is another source of stress in your life,” Kirby explains. “Sex is a very emotional experience. Arousal and lubrication are influenced by a plethora of variables, including emotions.”

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What Are the Causes of Sex-Related Pain and What Are the Treatments?

Kirby suggests consulting a sex therapist, a qualified healthcare practitioner who can assist you in coping with stresses as they arise. Additionally, you may engage with a mental health expert to work through any previous trauma that may be contributing to your sex discomfort.

When should you seek medical attention for painful sex

There are many possible causes of pain, and it is difficult (and dangerous) to identify them at home.

“It’s a really difficult situation. Whatever the cause, sex may be very distressing for both the sufferer and their partner,” Kirby explains.

While discussing sex with your doctor may seem awkward, do not suffer in silence. If you’re experiencing discomfort during sex, a short examination may mean improving your reproductive health and addressing any problems that are giving you agony.

Soon, you’ll be able to return to date night – painlessly.

What Are the Causes of Sex-Related Pain and What Are the Treatments?

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