Endometriosis pain after sex

What to Do When Sex Hurts With Endometriosis

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Many women with endometriosis say that intercourse hurts. In fact, about two-thirds of women with endometriosis have sexual dysfunction of some type, according to an analysis published in 2017 in Reproductive Sciences.

Pain with intercourse, or dyspareunia, is different for every woman. Some women say the pain is mild while others describe it as sharp and stabbing. Some report a deep, widespread aching. Many say there’s pain with penetration of any kind, while others say it only hurts with very deep penetration.

And while some women say it only hurts during actual intercourse, others describe pain that lasts for hours after sex — sometimes even up to two days.

For most women, it’s the location rather than the size of the endometriosis lesions that determines the amount of pain that’s felt, according to endometriosis.org. If the misplaced endometrial tissue is behind the vagina and the lower part of the uterus, and affecting uterine nerves or ligaments, intercourse is likely to be more painful because thrusting during sex pushes and pulls at the growths. And sometimes women feel pain with intercourse because the vagina is dry from hormone treatment or a hysterectomy.

How to Reduce Endometriosis Pain During Intercourse

Anxiety about sex being painful can also make things difficult. “When there’s pain during intercourse, over a period of time, tension plays a big role,” explains John C. Petrozza, MD, an obstetrician-gynecologist and chief of reproductive medicine and in vitro fertilization at Massachusetts General Hospital Fertility Center in Boston.

“A woman then anticipates pain, which creates a difficult emotional state,” says Dr. Petrozza. “You’re anxious to please your partner, but fearful of post-coital pain. The tendency is to tense up, and sex becomes more painful even with penetration,” he says.

The first step:Talk to your gynecologist and your other doctors. If you feel embarrassed about discussing this topic, remember that your sexual function is part of your overall health as a human being. Sexual functioning and response is complex, and involves not just your physical but your psychological and relationship health. The authors from the analysis published in Reproductive Sciences say that ideally, women who experience pain during sex should get input and advice from a team of people that includes gynecologists, psychologists, and even sexologists.

If you have endometriosis and sex hurts, you can also try these strategies:

  • Experiment with different positions. “The old-fashioned missionary position is the most painful — the uterus is tilted to your back (at its most posterior aspect), so it hurts the most,” says Petrozza. “Side to side and doggy style positions are a little bit more comfortable because of the angle at which the penis enters.” If you have a hard time finding a position that feels enjoyable, try alternatives to intercourse such as kissing, massage, and mutual fondling.
  • Time it right. “Intercourse may be less painful at certain times during your menstrual cycle,” says Petrozza. If you’re like the many women who tend to have mid-cycle pain (during ovulation), your window of opportunity may be from the last day of your period until just before ovulation, then again after ovulation until a few days before your next period begins. Experiment with this timing to see if it helps.
  • Talk to your partner about how you’re feeling. Your first instinct might be to hide your pain, but for your own comfort and the health of your relationship, it’s not a good long-term solution. Your partner could misinterpret your lack of interest and enjoyment, putting even more of a strain on your relationship. “I have patients bring their partner to the office,” says Petrozza. “For a lot of women, the partner doesn’t believe them or doesn’t understand why they’re hurting. They’ll say, ‘How bad could it be?’ This empowers the patient — they can say ‘This is something real; I’m not making this up.’ For the partner, it educates them, helps them get involved in the decision-making process of ‘Do you want to try medicine?’ or ‘Are we going to have to do surgery?’” If your partner won’t communicate or be part of the process, Petrozza suggests bringing in a friend or family member who can provide support.

If these strategies aren’t enough to make things better, talk to your doctor about medical treatments for endometriosis, such as taking birth control pills or other hormone therapies to lessen the size of the endometriosis lesions.

And if you haven’t been diagnosed with endometriosis but experience pain during intercourse, talk to your doctor. This pain is often an early sign of the disease, and things will turn out better if you get a diagnosis and treatment sooner rather than later.

Additional reporting by Andrea Peirce

As if the effects of endometriosis weren’t painful enough—heavy periods, cramping, digestive distress—the common condition also sabotages one of the most universal sources of pleasure known to humankind: sex.

Sounds like a cruel joke, right? But it’s true—a roll in the sheets is often far from blissful when you’re suffering from this disease, in which a woman’s uterine lining grows outside of her uterus and causes major discomfort at certain points in her menstrual cycle. “Painful sex is a common symptom because endometriosis implants distort the anatomy of the pelvis, the precise area where the penis contacts during sex,” says Iris Orbuch, MD, an OB/GYN who specializes in treating the condition. “Endometriosis often grows in the area behind the cervix , causing thickening, scarring, and adhesions. These cause lots of pain during sex.”

However, experts tell me that many women aren’t asking their care teams how to make sex more comfortable when they’re seeking relief from their endometriosis symptoms. “They’re so focused on what they can do to get better that it’s a secondary problem,” says women’s hormone expert Alisa Vitti, a Well+Good Council member and creator of the FLOLiving protocol and app.

But ignoring painful sex—whether you have endometriosis or not—is a source of stress that can potentially come with major consequences. “It takes a huge psycho-emotional toll because sex is a basic human function,” sexological bodyworker Kimberly Johnson points out. Contrary to how it may seem, an endometriosis diagnosis doesn’t mean you need to resign yourself to a life of celibacy. There are things you can do to make your booty calls the euphoric experiences they’re meant to be, which may have a knock-on effect when it comes to relieving the pain of your other symptoms.

To that end, I asked experts to share their most effective sex tips for women with endometriosis. Their answers ranged from bedroom hacks to alt-wellness treatments to suggestions that may seem completely unrelated to sex on the surface. The best part? Many of them don’t even require a partner—just an open mind.

Read on for 6 expert sex tips for women with endometriosis.

Photo: Stocksy/Sveta SH

Create an “erogenous map” of your body

Rather than focusing on the painful aspects of sex, it’s important to figure out what does feel good to you, says Johnson. “Pain is a circuit, so if you’ve experienced painful sex, that area of your body is associated with being uncomfortable. One way is developing pleasure circuitry.”

Vitti agrees, suggesting that this is a process that you can engage in solo. “It would be valuable for women to explore vaginally and build an ‘erogenous map,’” she says. “What sections of the vagina feel okay when stimulated internally? Knowing that, you can position your partner accordingly and avoid an area that might be more sensitive.” Sex therapist Vanessa Marin says tools like The Liberator can help you stimulate the feel-good zones during sex while keeping pressure off of the sore spots. “These kinds of supportive pillows and wedges can change the angle of sex positions that are typically painful,” she notes.

“There are plenty of other things you can do in the bedroom that don’t involve penetration.”—Vanessa Marin, sex therapist

On the other hand, you may discover that no form of penetration feels good. But that’s definitely not a deal-breaker, says Marin. “There are plenty of other things you can do in the bedroom,” she points out. “Manual stimulation and oral sex tend to be more pleasurable for most women—even those without endometriosis.”

Johnson also suggests looking beyond the area between your legs for erogenous zones—and don’t be shy about telling your partner what you discover. “Women need to take the reins,” Johnson stresses. “Men don’t feel particularly empowered to make suggestions because women are saying are uncomfortable, but they’re not saying, ‘Why don’t we try something else?’ Like, ‘I want to explore breast massage and see how that goes,’ or ‘I want to witness you self-pleasuring.’” (And obviously, this goes for same-sex and non-binary relationships, too.)

Photo: Stocksy/Guille Faingold

Don’t skimp on foreplay

Pre-gaming in the sack is a good-sex must for every woman, but it’s especially crucial for those with endometriosis. “Foreplay can be very helpful because it increases lubrication and can help a woman’s pelvic floor muscles to relax,” says Dr. Orbuch. She notes that women with endo tend to have tenser pelvic floor muscles than others—as a result of the body’s default pain response—and this can result in discomfort during sex.

Vitti adds that foreplay causes the vaginal tissue to become engorged, which can create a buffer between the vagina and the painful endometriosis deposits that may be surrounding it. “Don’t skimp on your arousal process, especially if you have endo,” she says. “Without it, your vaginal walls are thinner, which is not helping you.”

Photo: Stocksy/Mosuno

Seek out expert help—traditional and holistic

If you know you’re going to get busy, there are things you can do before the main event to prep for the best sex possible. For a DIY fix, Vitti recommends the regular use of castor oil packs, which have been shown to help reduce inflammation. “These have been used for centuries,” she says. Simply soak a swatch of flannel in castor oil, wrap it in a cotton dish towel, place it on your abdomen, and put a hot water bottle on top. “The heat allows the castor oil to do its job and penetrate,” Vitti explains. “Studies show it gets down to the tissue you’re wanting to affect unlike any other substance.”

Johnson’s clients have seen great results from vaginal steaming for painful sex. “Vaginal steaming can help with inflammation and it’s relaxing,” she says. “A lot of people find it really helpful to steam before sex because more blood flow goes to the genitals and the tissues get engorged.” Many Chinese medicine practitioners and Ayurvedic spas offer the service, or you can do it at home with a steam chair and pre-blended herbs.

From a Western-medicine perspective, Dr. Orbuch often suggests pelvic floor physical therapy for her patients, which usually involves massage-like manipulation of the area. “Most endometriosis patients feel much better with pelvic floor physical therapy over time, as the muscles relax,” she says. And if you’re considering surgery to relieve your symptoms, she recommends a laparoscopic procedure called excision surgery to remove painful endometriosis implants. (But of course, talk to your doctor about what’s best for you.)

Photo: Stocksy/Cameron Whitman

Find your hormonal sweet spot

According to Vitti, the first half of your menstrual cycle is usually a more comfortable time for sex if you have endometriosis, so plan your romps accordingly. “From the moment of ovulation to when you start to bleed—which is a good portion of the cycle—your endometrial tissue is going to be stimulated with estrogen and it’s going to be more sensitive,” she says.

This is especially true if you’ve got excess estrogen in your system, as many women do. “We’re living in an environment with a lot of , and in many of cases, an inability to detox them through the liver,” explains Johnson.

The answer? “You want to flush the estrogen from your body as quickly as possible to have less of it circulating in your system,” says Vitti. “There’s a lot you can do. Eat fiber-rich foods to make sure you’re moving your bowels daily, take supplements that mitigate effects on the body, and make sure that you’ve gotten rid of the endocrine-disrupting chemicals you’re exposed to, from pesticides in food to dry-cleaning chemicals on your clothes.” Do this and you’re likely to feel more balanced all month long, not just in the weeks leading up to your period.

Photo: Stocksy/Thais Ramos Varela

Stress less

One of the less-obvious triggers for painful sex is stress, according to Johnson. “If your system can’t down-regulate, it’s going to create inflammation,” she says—inflammation being a major cause of endometriosis-related pain.

This stress can come from the usual avenues, like work or toxic friendships, but it can also come from the endometriosis itself. “A lot of women start anticipating being in pain, then start feeling anxiety from that anticipation,” says Marin. “It can turn into a horrible spiral.” That’s why she suggests engaging in mindfulness practices, like meditation. “Mindfulness can help you stop your thoughts before they careen out of control,” she says.

Dr. Orbuch’s preferred form of stress relief is acupuncture. “Acupuncture helps to down-regulate the central nervous system that is revved up due to pain from endometriosis,” she says. “It also can help calm down muscle tightness and spasm.”

But for some women, adding a new wellness practice or standing appointment to an already-packed schedule will just make you more stressed. That’s why Johnson’s a fan of simply doing more of the things that make you happy, rather than the things that you think you should be doing. “It’s about building pleasure into life,” she says. So yes, in a roundabout way, Netflix binges can actually have a positive impact on your sex life, if that’s what helps you to chill out at the end of the day.

Photo: Stocksy/Clique Images

Keep it real with your partner

Talking to your partner about your discomfort during sex is never exactly fun, but Marin says it’s vitally important for your happiness and the health of your relationship. “Recent studies have shown that a great number of women experience pain during sex, but are afraid to talk to their partners,” she says. “But if you don’t talk to your partner, the pain will get worse, and you’ll probably start to develop resentment, too.”

And if they aren’t willing to accommodate your needs—say, if you want to take penetrative sex off the table because it’s just too darn uncomfortable and they’re pushing back—it may be time to enlist the help of a sex therapist or reconsider the relationship altogether. “It’s really important that your partner serve as your teammate,” Marin says. “It’s natural for both of you to feel disappointed if your endometriosis is affecting your sex life, but your partner should be supportive and non-pressuring.” Because at the end of the day, sex should feel good for all parties involved. It may just take redefining your definition of sex to get there.

Here are a few more ways to deal if you’ve got a lower sex drive than your partner—or vice versa. And if you’ve decided that you need some expert intervention, this is what seeing a sex therapist is really like.

Pain During Sex? It Could Be Endometriosis

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There are many reasons, both physical and psychological, why sexual intercourse can be painful. One cause that may be overlooked is endometriosis, a condition in which benign uterine tissue (endometrium, the cellular tissue that lines the inner uterus) grows outside the uterus where it can adhere to other organs or cause scar tissue. It is often not diagnosed for years because the symptoms can be confused with menstrual pains.

Pain during sex, called dyspareunia, should not be ignored. If endometriosis is causing it, there are treatments that can reduce or eliminate the problem.

How Endometriosis Can Cause Painful Sex

Women with endometriosis are about nine times as likely to experience painful intercourse as those without it. If you feel pain during deep penetration rather than initial entry, it may be due to endometriosis. The discomfort often comes from endometrial tissue, called implants, forming behind the vagina and the lower part of the uterus, where sexual activity can pull and stretch that tissue.

Women have described the pain as sharp or a deep ache, and it may be mild or severe. You may feel it during intercourse, or any time within a day or two of sexual activity. Intercourse is most likely to be painful around your period, when the endometrial implants swell. Endometriosis can also affect fertility, so if you are hoping to get pregnant, it’s important to discuss your symptoms with your Ob/Gyn.

What You Can Do About Painful Sex Caused by Endometriosis

Your doctor has effective treatments for most cases of endometriosis. Hormone therapy works for 90% of women with the condition, which suppresses your menstrual cycle so that the endometrial tissue doesn’t swell or bleed. If hormone therapy doesn’t provide relief or you are trying to get pregnant, your doctor may advise minimally invasive surgery to remove endometrial tissue.

Rarely, more extensive surgery or a partial or total hysterectomy or removal of the ovaries is needed to address endometriosis. Be sure you understand the risks and benefits of these procedures, as you will not be able to become pregnant and if your ovaries are removed, you will go into menopause.

There are also techniques you can try yourself to reduce the discomfort. Relaxation can help; try taking a bath or meditating before sex. You can try an over-the-counter pain medicine, and make sure to empty your bladder before engaging in sex. Set aside plenty of time for foreplay and try lubricants.

You may be able to find pleasure in intercourse if it is shallow or if the movements are slow and gentle, or learn that a certain position is better for you. You may also find that timing is important; intercourse may feel good at certain times during your menstrual cycle and not others.

If you have burning afterwards, try applying an ice pack, wrapped in thin material like a pillowcase or T-shirt, to your vulva. You can also consider alternatives to intercourse, like massage, oral sex, or masturbation.

Don’t Stay Silent About Pain During Sex

Communication with your partner is key to finding ways to help with painful sex, whether caused by endometriosis or other factors. Talk to your partner about what works for you and what doesn’t. Make sure he or she knows to stop if you say you’re feeling pain.

If sexual intercourse is painful on a regular or recurring basis, don’t wait to see your doctor. Your Ob/Gyn can determine if your symptoms are the result of endometriosis and help you find effective treatment and relief.

Painful Intercourse

Painful sexual intercourse, called dyspareunia in medical terminology (pronounced “dis-pair-une-ee-ah”), is a common complaint among women seeking gynecologic care. Many women report occasional pain with intercourse, but some women have pain with every episode of sexual relations. Although it may take a few visits to a gynecologist or other health care provider experienced in women’s health, the cause of dyspareunia can usually be identified and treated.

There are three main types of painful intercourse. Perhaps the least common is pain that occurs only after intercourse or orgasm. This can be due to uterine contractions from orgasm. Women with this problem may get relief by taking medications like ibuprofen before intercourse, which can block pain from uterine contractions. Another source of this type of pain is an allergy to semen, which is actually quite uncommon. After her partner ejaculates there can be an intense burning sensation and redness around the vagina and vulva (the outer “lips” of the vagina). There have actually been a few reported cases of women going into shock after sexual intercourse due to an allergy to semen. A third cause of pain after intercourse is a vaginal infection, such as a yeast infection, which can cause a burning sensation within the vagina due to irritation.

Pain immediately upon penetration or touching the outer lips of the vagina can be caused by a variety of medical problems. For example, herpes infections cause blisters which are very tender to the touch. A scrape or small cut at the entrance to the vagina can create pain. Some women have a hymen that does not completely resolve after their first few attempts at intercourse, which can cause an intensely painful sensation upon penetration. Some infections, such as yeast infections or bacterial vaginosis, create irritation of the vulvar or vaginal tissue, leading to immediate pain with sex. And, dermatological conditions such as squamous hyperplasia or lichen sclerosus may cause damage to the vulvar skin, making it tender to the touch. Inadequate lubrication may also cause pain. The diagnosis of these conditions requires a thorough gynecologic exam, and, in a few cases, a small biopsy of the skin using local anesthesia in the office. Another problem that can cause entry pain is vaginismus, where the vaginal muscles contract involuntarily, making penetration extremely painful or impossible. This may be due to a subconscious response to prior pain, where the body tries to protect itself from pain by “closing off” the vagina, or may be due to psychological pain, in women who have an abuse history or who are fearful of sexual activity. As with any condition with a potential psychological component, there is controversy about this disorder. I have found it uncommon in my practice, but it must be considered in the differential diagnosis of conditions that can cause painful intercourse. Treatment for these conditions is antibiotics for infection, steroid creams for the dermatological problems, a vaginal dilator or minor surgery for a partially intact hymen, and counseling and vaginal dilators for vaginismus. Lack of lubrication can be treated with water-based lubricants (NOT Vaseline, which may be harmful to vaginal tissues).

Probably the most common type of pain with intercourse is “deep thrust” dyspareunia, where deep penile penetration causes pain. This is common during passionate sexual relations, and can come and go depending on the position used during intercourse. Many conditions can cause this type of pain, including a prolapsed uterus (where the cervix and uterus are “falling out” of the vagina due to relaxation of the tissues that hold them up within the vagina), a “fallen bladder” due to childbirth, scar tissue around the uterus or ovaries (called adhesions), an ovarian cyst (although this is an uncommon cause of such pain), large uterine fibroids (non-cancerous tumors of the uterus), and endometriosis, a condition where tiny implants of blood from the uterus stick to the female organs and cause pain. Many women suffer from irritable bowel syndrome, and intercourse can cause the uterus to hit the intestines, causing pain. Medical studies have shown that many women with this condition are reluctant to engage in sexual relations due to fear of pain or accidental release of gas or feces during intercourse. Some of these causes of deep-thrust dyspareunia are difficult to diagnose, and may require multiple exams and even outpatient laparoscopic surgery. Laparoscopy, sometimes called “belly button surgery” is an outpatient surgery where a lighted tube is inserted into the belly button to directly view the internal pelvic (female) organs to diagnose and treat problems. Treatment of these conditions may require various medications or even surgery, and requires the input of a health care professional experienced with these types of problems.

In summary, a number of conditions can cause painful intercourse. Contrary to popular belief, psychological causes are very unusual, and medical causes are usually the culprit. Therefore, women experiencing painful intercourse on a regular basis should seek the care of a gynecologist or other women’s health care provider with experience in painful intercourse. With a little detective work and cooperation between the patient and her doctor, treatment can be provided that will lead to a more healthy and enjoyable sex life.

Why Does My Vagina Burn After Sex? 7 Possible Reasons You May Be In Pain, According To An OB/GYN

Despite being a boatload of fun, sex doesn’t come without the occasional downsides. And one such downside is vaginal burning after intercourse. You know, because the weird noises, the suspicious smells, the possibility of a urinary tract infection, and a whole slew of other somewhat problematic issues weren’t enough. But just because your vagina burns after sex, it doesn’t necessarily mean doomsday. In fact, it’s a fairly common occurrence and can be the result of any number of things.

“There can be many causes of vaginal burning after intercourse and it is important to be evaluated if any of the symptoms linger,” Dr. Sheila Loanzon, board certified Obstetrician and Gynecologist, Fellow of the American Congress of Obstetrics and Gynecology, and author of Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups, tells Bustle, “It is important to distinguish between immediately after versus continued symptoms.”

While vaginal burning is something that you shouldn’t ignore, it’s also not something you need to completely freak out over. It’s important to deduce what could be the reason behind it and, if need be, go to your doctor to discuss how to remedy the situation. There’s nothing worse than having a great sex, and then laying there in pain afterward — so don’t.

Here are seven possible reasons why your vagina is burning after sex.

1. Anatomic Discrepancy

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As much as it pains me to write this, sometimes bodies just don’t line up well. This can create an issue. While it might feel good during, if your body and your partner’s body are too varied in the way they’re built, it can definitely cause some pain issues.

“Due to anatomic variations between partners, the friction that is generated from intercourse can cause vaginal burning as well as pain during and after intercourse,” says Dr. Loanzon. “A woman’s vaginal opening and/or male penile girth can cause vaginal skin stretching perceived as vaginal burning.”

2. Too Much Friction During Sex

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“If there are issues with lubrication, lack of foreplay, or perhaps aggressive intercourse, this can cause vaginal burning afterwards,” says Dr. Loanzon. “It is important to engage in foreplay to prepare the vaginal tissue, and consider using lubricant to help as well.”

This is just another friendly reminder about how important foreplay is to the female anatomy. Remember: it takes at least 20 minutes for a woman to become fully aroused.

3. Possible Vaginal Infections

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Although the vagina is totally badass and can, for the most part, take care of herself, infections happen. Stress, for example, can bring on a yeast infections like it’s nobody’s business! So, yes, infections are common, but when they strike and aren’t taken care of, they can mess with your sex life.

“Yeast and bacterial infections caused by changes in the vaginal pH can cause intercourse to be painful and burn afterwards,” says Dr. Loanzon. “It is important to be seen by a health care provider to reassure you if an infection is present or not.”

4. Certain Brands Of Lubrication

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If you’re naturally on the dry side or taking a medication that’s preventing you from getting wet, lube is a great idea. But not all lube is the same and it’s something worth noting.

“Those fancy lubes found at the grocery store with explosions and fireworks for men and women can also causes vaginal burning,” says Dr. Loanzon. “It may be due to an insensitivity or allergic reaction to the lubricants so be aware if you have sensitive skin!”

I’m not going to name names, but I tried one of those “explosion-promising” lubes that Dr. Loanzon mentions and it caused a level of burning that I hadn’t experienced before or since. Stick to water-based, regular ol’ lube.

5. Too Much Sex

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“If there is marathon sex occurring this can also cause vaginal burning,” says Dr. Loanzon.

Whether you’ve done it six times in one night (go you!) or having it a couple times a day for several days in a row, it might be time to ease up. Like anything, your vagina sometimes needs a vacation and there are a lot of other things, besides intercourse, that are just as fun.

6. Undiagnosed STIs

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“Sometimes the burning you are feeling may be due to undiagnosed STDs,” says Dr. Loanzon. “Rarely would burning be due to HIV or syphilis, however gonorrhea and chlamydia can present as burning. A person who has a history of herpes can present with symptoms of vaginal burning, tingling, despite the presence of a sore. If you are having unprotected intercourse (don’t!) consider an STD check to confirm symptoms.”

In other words, stay up to date on your vaginal health and get tested at least once a year for STIs, or more if you think something might be up.

7. Age

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“Based on age, if you are close to menopause, vaginal burning may be the sign of ‘atrophic vaginitis’,” says Dr. Loanzon. “This is thinning of the vaginal tissue due to decreasing estrogen and this may present as vaginal burning after intercourse. This is age related so it’s important to see a gynecologist to confirm as there can be various treatments prescribed that may help with this symptom.”

Although it’s definitely not fun and can be a totally a hassle, vaginal burning after sex is common. It’s just all about figuring out where the problem is stemming from, then taking the steps to fix it.

Q: I have lost interest in having intercourse with my husband because many times I get a burning sensation. Also, I often get infections afterwards. Do other women experience this problem and what can be done about it?

One of the most common causes of painful sex in women is vulvodynia, defined as discomfort or burning pain in the vulvar area with no obvious cause, such as an infection, cancer, or neurologic disorder like herpes or spinal nerve compression. This common cause of vaginal pain is frequently misdiagnosed. The condition is estimated to affect about 16 percent of women; a number some researchers suspect may be much higher. The pain often prevents women from exercising, having intercourse, and, in extreme cases, even walking.

READ: Does Your Vagina Burn During Sex?
No one really knows what causes it, although some theories suggest it may come on in relation to a particular event, like childbirth, infection or surgery. Other possible reasons include genital infections, physical or sexual violence, or even women with the condition may have lower pain thresholds than women without. One study found that women with VVS have fewer estrogen receptors in the vulvar region, which may relate to their increased pain sensations.
Make sure you tell your health care professional you want to be evaluated for vulvodynia; in one of the few surveys to look at the issue of diagnosis, only nine percent of women who sought treatment received a diagnosis of chronic vulvar pain; the rest were diagnosed as having some form of vaginal or pelvic infection or other condition.
There are many possible treatments for vulvodynia, ranging from diet, Kegels (exercises that strengthen the pelvic floor) and biofeedback, to medical approaches including low doses of antidepressants and lidocaine ointment used at night to numb the vulva. For severe cases, doctors may inject anti-inflammatory chemicals called interferon alfa into the vulvar vestibule, the folds around the vagina, three times a week for four weeks. Studies find some benefits in some women, possibly because it relieves painful inflammation.
You also may be experiencing vaginal dryness, most common in women over 40 and especially those who are postmenopausal. The loss of estrogen after menopause causes thinning in the walls of the vagina and the urethra and dries vaginal secretions, leading to pain during intercourse. It also increases your risk of vaginal infections, like vaginitis, and can cause urinary problems.
Luckily, there are several treatments available, ranging from over-the-counter water-soluble lubricants, which you can find in most local drugstores, to prescription hormone creams suppositories, and even a diaphragm-like device you insert into the vagina. Unlike oral estrogen, the hormone creams are only absorbed somewhat by your body; the suppositories and ring are not, and so are thought to carry fewer health risks.
It’s very important that you talk to your health care professional about this problem, because numerous other medical conditions can cause vaginal pain such as you’re describing, many of which can be easily treated. Also, it’s very important that you and your husband are tested when you have an infection.
When you do see a health care professional for this problem, you should receive a thorough medical history and pelvic exam, including cultures for fungal and bacterial infections, and a test for bacterial vaginosis. A common test for vulvar pain involves using a moist, cotton-tipped swab applied to the various areas of the vulva to pinpoint areas of pain.
And, of course, it’s important that your husband understand the reason behind your lack of interest in sex. Tell him about the pain, and assure him that it’s not something he’s doing. Also make sure he knows you’re seeking help—and that your sex life should return to normal soon.

Endometriosis occurs when endometriotic tissue (which typically lines the uterus) is found outside the uterus. This tissue might be found on the ovaries, fallopian tubes, bladder, rectum, or intestines. It can also appear on the peritoneum, the membrane that lines the abdominal cavity.

The main symptom of endometriosis is chronic pelvic pain, which may worsen before and during a woman’s menstrual period. Depending on where the endometrial tissue is located, a woman may have pain when urinating or having a bowel movement.

Sexual Pain

Endometriosis can also cause sexual pain, especially if the tissue is near the vagina. The pain may be mild or severe. Some women describe it as a stabbing pain. Thrusting from the penis can irritate the growths and pain may get worse as penetration deepens. Sometimes, the pain remains after intercourse, from a few hours to a couple of days.

The anticipation of pain can make a woman tense, adding to a cycle of pain.

Emotional Issues

Feelings of inadequacy and concerns about partners are common in women with endometriosis. They may feel guilty, frustrated, or depressed because they can’t have sex the way they used to.

Relationship Issues

Endometriosis can lead to a number of relationship problems. Some women avoid sex because of the pain. Partners may feel rejected. Some couples drift apart and stop being intimate. Women may worry that their relationship will end because of endometriosis. Many couples find themselves unable to talk about the problem.

Other Sexual Issues

Taken together, the above issues can contribute to less sexual satisfaction and desire. Women with endometriosis may also have fewer orgasms.

Fortunately, there are some ways to cope with sexual difficulties caused by endometriosis.

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