Painful Intercourse & Sexual Dysfunction

Sexual dysfunction refers to a difficulty experienced by a woman that inhibits satisfaction from sexual activity. Symptoms vary depending on which type of sexual dysfunction you are experiencing:

• Desire disorder – lack of interest in sex or sexual desire, also known as low libido
• Arousal disorder – inability to become physically aroused or excited during sexual activity
• Orgasmic disorder – persistent or recurring difficulty in achieving orgasm (climax)
• Sexual pain disorder – pain associated with vaginal contact and sexual stimulation, including dyspareunia (painful intercourse)

Sexual dysfunction is very common, with about 43% of women reporting that they have experienced some type of sexual dysfunction. If sexual problems worry you or are affecting your relationship, see your doctor.

Your doctor will talk with you about possible causes for your sexual dysfunction to arrive at a treatment plan that is right for you. Causes are often interrelated and may include:

• Physiologic issues
• Psychological conditions
• Hormone shifts post-pregnancy, during perimenopause or postmenopause
• Certain medications, such as antidepressants or high blood pressure medications
• Diabetes
• Hypertension
• Cardiovascular disease
• Neurological disorders
• Life stressors such as marital conflict, infertility issues, childbirth or an overly busy lifestyle

Talking with your primary care physician, gynecologist or OB/GYN can help pinpoint the source or sources of your sexual dysfunction. Your doctor may order diagnostic tests to rule out medical issues. You may also be asked about your attitudes and other possible contributing factors, such as trauma, medication or alcohol or drug abuse.

Sexual dysfunction can be addressed by treating the underlying cause. Some common treatment options include:

• Home remedies. You and your partner can change positions, better communicate, have longer foreplay, try a device, or use over the counter lubricants.
• Healthy lifestyle habits. Limit alcohol, quit smoking, get regular physical activity and decrease your stress.
• Medication. If your pain is caused by an infection or medical condition, medication might resolve your problem. Your doctor may prescribe a new medication. Alternatively, you may be asked to switch medications if your current medicine is known to cause lubrication issues.
• Lubrication. If your pain is caused by vaginal dryness due to menopause, your doctor may recommend estrogen creams, tablets, rings or other medications.
• Manual therapy by a pelvic floor physical therapist. Just like physical therapy performed on other parts of the body such as the back or neck, specially trained pelvic floor therapists target the deep muscles, tendons, ligaments, nerves, and organs that can be causing pelvic/vaginal pain or dysfunction. Trigger point release directly to the pelvic floor/vaginal muscles is used to decrease muscle tension, nerve sensitivity and inflammation while increasing blood flow and improving tissue quality. Other modalities may be used to decrease nerve sensitivity, break up bound or scarred tissue, decrease inflammation, and re-educate muscles.  The Hoag Pelvic Health Program offers a team of dedicated physical therapists as well as credentialed practitioners who provide integrative wellness therapies such as acupuncture, Pilates, guided imagery and massage therapy. Learn more here.
• Counseling or sex therapy with a Licensed Marriage and Family Therapist (LMFT). A licensed marriage and family therapist can help you cope with sexual issues, have more comfortable sexual experiences and to better understand your sexuality. They can assess your progress and identify underlying psychological issues that might contribute to both sexual problems and chronic pelvic pain conditions. Learn more here.
• Surgery. In some cases, surgery will be recommended to correct anatomical issues or remove painful growths.

Dyspareunia is the medical term for persistent or recurrent genital pain that occurs just before, during or after sex. Your doctor will ask you about symptoms, including:

• Pain during sexual penetration
• Pain with every penetration, including putting in a tampon
• Deep pain during thrusting
• Burning pain or aching pain
• Throbbing pain, lasting hours after intercourse

Several studies have reported that 30 percent of U.S. women suffer from dyspareunia, and the American Journal of Obstetrics and Gynecology reported that 22 percent of women had pain when attempting intercourse six months after delivery of their baby.

You will likely undergo a pelvic exam to check for skin irritation, infection or anatomical problems. Your doctor may order a pelvic ultrasound to check for growths or other conditions. You may also be asked whether you feel your pain is associated with stress or a history of sexual abuse or trauma.

Depending on the cause of your pain, treatment can include:

• Lifestyle and home remedies. You and your partner can try to change positions, better communicate, have longer foreplay, or over the counter lubricants.
• Medication. If your pain is caused by an infection or medical condition, medication might resolve your problem. Alternatively, you may be asked to switch medications if your current medicine is known to cause lubrication issues.
• Lubrication. If your pain is caused by vaginal dryness due to menopause, your doctor may recommend estrogen creams, tablets, rings or other medications.
• Manual therapy by a pelvic floor physical therapist. Just like physical therapy performed on other parts of the body such as the back or neck, specially trained pelvic floor therapists target the deep muscles, tendons, ligaments, nerves, and organs that can be causing pelvic/vaginal pain or dysfunction. Trigger point release directly to the pelvic floor/vaginal muscles is used to decrease muscle tension, nerve sensitivity and inflammation while increasing blood flow and improving tissue quality. Other modalities may be used to decrease nerve sensitivity, break up bound or scarred tissue, decrease inflammation, and re-educate muscles.  The Hoag Pelvic Health Program offers a team of dedicated physical therapists as well as credentialed practitioners who provide integrative wellness therapies such as acupuncture, Pilates, guided imagery and massage therapy. Learn more here.
• Counseling or sex therapy with a Licensed Marriage and Family Therapist (LMFT). A licensed marriage and family therapist can help you cope with sexual issues, have more comfortable sexual experiences and to better understand your sexuality. They can assess your progress and identify underlying psychological issues that might contribute to both sexual problems and chronic pelvic pain conditions. Learn more here.
• Surgery. In some cases, surgery will be recommended to correct anatomical issues or remove painful growths.