Should Sex Hurt?

As a gynecologist I’ve learned that every woman’s definition of  “normal” is different. This is especially true concerning sex. I have seen women who put up with pain for years thinking it’s normal, while others come to my office with every twinge.

Sex should be a highlight of the marriage relationship, not something looked at with painful dread. 

Sex should not hurt ALL the time. Here are some of the more common causes of pain with sex and the treatments to help you get your groove back.

Common Causes of Chronic Sexual Pain

Endometriosis. Endometriosis is a chronic disease where the tissue that normally grows on the inside of your uterus begin to also grow inside your abdomen, forming painful scar tissue. Women with endometriosis will often have severe period cramps, painful sex and a harder time conceiving.  Often women will describe a deep pain with thrust and then an aching sensation in their pelvis after sex. Common treatments for Endometriosis include hormonal therapy and surgery.

Interstial Cystitis. IC is a condition of bladder inflammation. Often women feel like they have a bladder infection, but no signs of infection show up on tests. The front wall of the vagina is actually attached to the bladder with this condition. Vaginal pressure during intercourse pulls on the bladder, causing tenderness. IC can be treated by medication and dietary changes and is usually treated by a urologist.

Vaginismus. The vagina is supported by a series of muscles that stretch from the abdominal wall to the lower back, called the pelvic floor. These muscles can spasm involuntarily, causing a condition called vaginismus. Women with vaginismus sometimes have a history of abuse. Often these women are unable to use tampons and cannot physically have sex due to pain and spasms. This condition can be treated with pelvic physical therapy, counseling and relaxation techniques.

Vestibulitis. Vestibulitis is caused by inflammation of the glands at the vaginal opening. This can sometimes be caused by chronic yeast infections. The inflammation results in pain when the vaginal opening is touched or the penis is inserted. Treatment can include numbing gel as well as treatment of the underlying infections.

Vaginal Dryness. The vagina is extremely sensitive to your body’s estrogen levels. When the body is low on estrogen, the vaginal tissue begins to thin, natural lubrication diminishes, and blood flow decreases. The most common time for this to occur is menopause, but it can also be seen in breastfeeding women or while on certain medications. Depoprovera, Lupron and birth control pills are a few common culprits.  Adding lubricant is the first treatment {coconut oil is a great all-natural option}. If pain persists, there are several medical treatments for this condition.

Common Causes of Occasional Sexual Pain 

Infection. Bladder infections, yeast infection and herpes are common causes of painful intercourse. Most result in a pain with insertion as well as a burning pain after intercourse. Some women will also note an odor and discharge. If you think you have a yeast infection and over the counter therapies aren’t working, it’s time to see your provider.

Constipation. The posterior wall of the vagina is attached to the rectum. In addition, the pelvic floor muscles that support the vagina also support the colon. When you are bloated and constipated, it can cause discomfort with intercourse. If your poop comes out in hard round balls, that is constipation {even if you go everyday}. Increase your fiber and water intake for initial treatment of constipation. If you have chronic constipation see your doctor.

Ovulation/Ovarian cyst. If you notice pain with intercourse mid cycle {2 weeks before your period is due to start} this is likely caused by ovulation. When the ovary releases its egg each month, a small cyst forms. Occasionally these cysts will fill with blood, causing an achy pain in your lower pelvis. Usually the pain with sex occurs with thrusting and improves with positional changes. The cysts {and pain} usually shrink by the next menstrual cycle.

Stress. A woman’s biggest sex organ sits between her ears. Often when life is stressful, women experience low sex drive. Additionally, just as some women experience tight shoulders or headaches with stress, other women can get tightness in the pelvic floor muscles. For some women, stress decreases lubrication. Sometimes a glass of wine, a hot bath and some extra lubricant can be a busy mom’s best friend in the bedroom.

Should sex hurt?

Occasionally there will be some mild discomfort, but it should not hurt all the time. If it does, you need to see your provider.

Have any specific questions about pain with sexual intercourse?

{Photo Credit}