The Most Common Causes Of Painful Sex – And What To Do About It
There are plenty of factors that cause painful sex, and plenty of reasons women stay quiet about it. But it's a condition that can be treated – and should be spoken about. Here's what you need to know about dyspareunia
When Anna Tan* had a hysterectomy seven years ago, she expected her health to improve. Instead, she developed a problem that has affected her physically, mentally and emotionally. It has been too hard for the normally confident life coach to talk about. The problem? Painful sex.
Anna is not alone. According to the American College of Gynaecologists, nearly three out of four women will experience painful intercourse at some point in time. The problem can be temporary, but studies have shown that up to a third of women will have persistent problems.
The medical term for pain before, during, or after vaginal intercourse is dyspareunia. According to women's health organisation Jean Hailes, it affects women of all ages. It's common in menopausal and postmenopausal women due to hormonal changes leading to vaginal dryness and decreased elasticity. Left unmanaged, it can lead to loss of sexual interest, mood changes, and relationship issues.
Management starts with acknowledging the problem. Gynaecologist Dr Elizabeth Farrell, a founder and medical director of Jean Hailes says, "There is help available. See your doctor and talk about it." If you don't feel comfortable discussing it with your doctor, try a different one, or a community or women's health nurse.
Here, find out more about what causes painful sex and the doctor-approved ways to solve the issue.
There are two types of dyspareunia. The first is superficial dyspareunia, which is pain on attempted penetration. Causes include infections, vaginismus (spasm of the pelvic floor muscles), and size disparity (where the erect penis is too big for the vaginal entrance). The second is deep dyspareunia, which is pain at the top of the vagina, often experienced with thrusting. Causes include pelvic diseases such as endometriosis, ovarian cysts and pelvic inflammatory disease.
Lack of lubrication can cause dyspareunia, says Dr Charlotte Elder, an obstetrician, gynaecologist and spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. This often affects women at menopause, and those who are breastfeeding.
"They generally have lower oestrogen levels, so they tend to make less lubrication themselves," she explains.
Another cause of poor lubrication is inadequate foreplay, explains Dr Elder, who prefers the term 'sex pain' to dyspareunia, because it is less medicalised. This can be a problem for older women who haven't had sex for a while and may not be confident articulating their needs.
Dr Elder likens foreplay for a woman to an erect penis for a man – a prerequisite for intercourse. "Foreplay is not an optional thing, a fun thing, or something that you do extra to sex. It's actually really important."
She recommends women speak to their doctor about lubrication issues. If low oestrogen is the cause, supplementation – whether as a vaginal cream or tablet, or a patch that works through the body – can be helpful. She reiterates that being comfortable with your doctor is crucial, so find one that's comfortable with women's health. Your GP may refer you to a gynaecologist if they have concerns or you have a complex gynaecological history.
When it comes to lubricants, oil- and even fruit-based ones may work better than water-based ones. "The main thing is to try them," Dr Elder advises. "Test them on your skin, vulva, then on your vagina and see how you feel."
"If people are feeling anxious or stressed, any pain will be worse – especially sex pain," Dr Elder explains. "Being in a situation where they're not going to feel pressured to have intercourse means that they can relax and it makes intimate activity more pleasurable."
Dr Farrell agrees, noting that some couples will choose to have 'outercourse', or intimacy without penetration. "Intimacy is different from sex and sex is not just about penetrative sex," she says. Couples can explore other ways to give and receive pleasure.
She adds that some partners will be really concerned and won't want to hurt you, whereas others may try to make you feel guilty. Seek the support you need from your doctor, counsellor or friends. Anna says taking someone along to medical appointments with you is also a good idea.
Aside from the physical effects, painful sex can be devastating mental health consequences
"The biggest mistake is bottling it all up," admits Anna. It also affects relationships. For Anna, intimacy with her partner declined because he didn't want to hurt her. "We have a loving relationship, but we're not intimate very often," she says. "I like sex a lot and that's been taken away."
These issues are all too common. Dr Janet Hall, a clinical psychologist, sex therapist and hypnotherapist, says, "Just one negative experience can result in a person trying to avoid having sex again. Psychological factors are often associated with previous sexual trauma (such as rape or abuse), feelings of guilt, or negative attitudes toward sex."
Dr Hall explains that psychological treatment is often necessary because the pain has caused fear due to anticipating future pain. Treatment may include strategies for changing negative thoughts, journal writing to identify fears, worksheets to help change mistaken beliefs, and using affirmations and visualisation to develop positive expectations about sex.
Secondly, physical strategies are used to foster positive bodily reactions. These include deep-breathing to lessen anxiety, progressive muscle relaxation to relax and experience body sensations, pelvic floor muscle exercises, and gradual practice of touching your own genitals and introducing penetration into your vagina.
"Hypnosis trains you to change your inner view and explore your real feelings," Dr Hall explains. "In hypnotherapy, you learn how to convert negative repressive images into positive, releasing ones." Dr Hall says that "many women have suffered in silence because they feel 'different', like a failure and think that they are the only one with this problem."
However, with the right help, they can "experience sex as a pleasure and not a pain." Dr Farrell, too, urges women not to suffer when help is available. "Go and see somebody who is interested and sees that it's taken you a lot of courage to come and talk about it." Anna regrets not seeking help earlier. Her advice to anyone suffering pain with sex is: "Get support quickly".
*not her real name
Text: bauersyndication.com.au
This article was originally published on The Singapore Women's Weekly on June 14, 2021.