Love hurts (sometimes)

Posted on 15 February, 2019

Valentine’s Day always puts the focus on love, romance and, yes… sex.

Unfortunately though for some women this may not be cause for celebration. If you are one of the estimated 20% of Australian women who experience pain with intercourse, date-nights might even be viewed with dread at the expectation that they will end in (painful) sex. So what are the causes of sexual pain, and what can you do about them?

A great way to work out the possible causes and communicate effectively with your doctor is to start by answering these questions:

How old are you?

An easy one to start with, but an important one. There are some causes of sexual pain that are more common at certain life stages; for example, a young girl is more likely to be tense during early sexual encounters and have a tight vaginal opening whereas a post-menopausal woman is more likely to experience vaginal thinning and dryness, or atrophy (awful word!) due to estrogen deficiency.

What is your sexual history?

Having multiple partners and not using condoms increases your chances of getting chlamydia, gonorrhoea, herpes and a gamut of other STI’s. Be particularly suspicious of these if you’ve recently had unprotected sex with a new partner, have an unpleasant discharge, new sores or blisters in the genital area, fever or persistent pelvic pain. These are key features of infective causes for pain so you absolutely must see a doctor for the right testing and treatment, and avoid intercourse until you’ve been checked out.

Where is the pain?

Is it on the outside or the inside? Superficial or deep? For example, pain on the vulval or labial areas suggests a completely different range of causes compared to pain only felt deep inside the vagina. During intercourse, pain that is felt with initial penetration of the vagina is called “superficial dyspareunia” whereas pain that is felt only higher up with deeper penetration or thrusting is call “deep dyspareunia”.

When does it happen?

Do you only have pain during intercourse or is it also with weeing/pooing/wiping, bike-riding, wearing tight jeans, etc? Is there pain right from the start of intercourse or does it gradually build up? Do you only feel it around the time of your period, mid-cycle, after waxing… try to work out if there are any particular activities associated with the pain.

Have you ever had sex that wasn’t painful?

If you have then something must have changed to make sex painful now. Try to pinpoint when things changed and what was happening at the time. Is it a different partner? Different sexual practices, toys, lubricants or other products? Have you had a baby? Had a traumatic sexual experience or assault?

Can you (or your partner) see or feel anything different?

If you’ve never “made friends with your fanny” then now would be a really good time to break out the hand mirror and get in there. There’s a wealth of potential clues to be found by looking at the vulva and vagina: is there any discoloration, sores, bleeding, tears or peeling skin on the vulva or labia? Can you see anything bulging from the vaginal opening? (This might indicate a prolapse) Is it tender to touch the skin or vaginal entrance? Can you put your fingers inside without pain? Can you feel anything unusual in the vagina?

Are there any other symptoms or significant medical conditions?

An autoimmune or skin disease for example may be linked to your stinging vulval pain. A history of anxiety might make the psychological aspects of sexual pain worse. Urinary leakage, frequency or pain may be hinting at an underlying prolapse or urinary tract infection. Vulval itch and redness make thrush a more likely. Consider your complete medical history and be sure to mention these things to your doctor.

Putting it all together…

Having considered these questions, you may now be closer to working out what the underlying cause is. Some of the more common ones are:

• Thrush
• Bacterial vaginosis
• Vaginal dryness or atrophy
• Skin disorder/ inflammation
• STI’s
• Vaginal muscle spasms (vaginismus)
• Psychological distress
• Pelvic nerve pain
• Vulvodynia (chronic vulval pain of unknown cause)

Check out this great information from Jean Hailes for Women’s Health with details about these and other potential causes of sexual pain.

Go to the doctor, my dear

If you’ve read my previous posts then this will come as no surprise: I strongly urge you to find a caring, knowledgeable women’s health doctor to help you with this. There are potentially serious causes for these symptoms so a thorough assessment by a medical professional is really important. If you have significant physical or psychological pain you may be fearful of examinations; this is reasonable and understandable.

Communicate this fear clearly to your doctor, and make sure that you trust them to be gentle and to stop if asked. You don’t have to submit to a painful or degrading examination, and it’s totally fine to ask for a friend or chaperone to be present.

If you’re not comfortable discussing this issue with your usual GP, or you haven’t got one, I can highly recommend the wonderful doctors and nurses at SHFPACT and the Canberra Sexual Health Centre.