When Sex Hurts
By Kelli R. Porter, Women’s Health Nurse Practitioner, NAMS Certified Menopause Practitioner
Sexual Health Awareness Month
Dyspareunia is genital pain that occurs before, during or after sexual intercourse. Patients may experience stinging or burning or feel deep pelvic pain. Many women are uncomfortable discussing this with their healthcare provider, but I encourage women to talk about it because it is quite common and can often be treated.
There are several conditions that can cause dyspareunia:
Infections – Vaginal or pelvic infections can cause painful intercourse. If vaginal tissues are inflamed because of a yeast or bacterial infection, sex can feel irritating or painful. Sexually transmitted infections like chlamydia, gonorrhea or trichomoniasis can cause pain as well. These infections can lead to pelvic inflammatory disease that may cause pain with deep penetration. Herpes viral infections can cause ulcerations which are very painful during sex. Once the lesions are healed the pain usually resolves.
Gynecologic conditions – Endometriosis, adenomyosis, ovarian cysts and uterine fibroids are just a few of the gynecologic conditions that can cause dyspareunia. Endometriosis and adenomyosis occur when endometrial tissue that is normally confined to the endometrial cavity inside the uterus is found in other areas such as around the fallopian tubes, ovaries, pelvic sidewalls, rectum or deep in the muscle wall of the uterus. Ovarian cysts can cause the ovary to be enlarged and tender, and can cause pain. Uterine fibroids are typically benign tumors of the uterus that can cause the uterus to enlarge. When enlarged, the uterus can cause pressure or pain to surrounding organs. These conditions can be easily diagnosed with pelvic imaging such as an ultrasound or MRI and management with medications or surgery is usually effective at eliminating the dyspareunia caused by them.
Urinary system disorders – A urinary tract infections does not just cause burning with urination, it may also cause pain with intercourse. When the bladder is inflamed, it can feel tender and may be felt as pain during sex. Interstitial cystitis is another condition affecting the bladder that may also first present as pain with sex.
Malignancies – Though rare, some cancers located in the pelvis may cause pain with sex. Ovarian, uterine, cervical and anal/rectal cancers may cause pain. It is important to discuss risk factors and pain with your healthcare provider and to have routine screening such as pap testing and colonoscopy as recommended.
Dermatologic conditions – Did you know some common skin conditions can affect the vulva? Eczema, psoriasis, lichen planus, and lichen sclerosus are just a few that can be found down below and may cause pain with intercourse. Treatment usually resolves the pain.
Menopausal changes – As if hot flashes and night sweats weren’t bad enough, there is another condition that often emerges around the time of menopause or even a few years after, called genitourinary syndrome of menopause. This is when the vulvar and vaginal tissues change because of lack of estrogen. The labia and clitoris thin and shrink, lose their elasticity, and become fragile. Sex can feel like the tissues are raw or ripping. I have had patients tell me sex feels like sandpaper rubbing – OUCH! Thankfully, there are many safe and effective treatments for this condition.
So, please do not suffer silently. Discuss your symptoms with your healthcare provider. Sex is an important, healthy part of a relationship and should not hurt.