Let’s talk about (painful) sex

There are a number of issues patients don’t like to discuss with their doctors, but really should. Whether they are related to their lifestyle — such as how much, or little, they exercise or how often they go to a fast food drive-thru — or to matters of life or death, including addiction or suicidality, patients often hold back vital information.

One common issue women tend to avoid talking about is painful sexual activity. And while it may not be a life-threatening condition, it is one that affects their quality of life.

According to the American College of Obstetricians and Gynecologists (ACOG), nearly 3 out of 4 women report experiencing pain during intercourse. This pain can be caused by a medical problem or issues with sexual response, such as a lack of desire or a lack of arousal, and is usually a temporary issue that can be treated.

“Some patients are not comfortable talking to their doctor about sexual difficulties,” says Dr. Latisa Carson, an OBGYN affiliated with Sharp Chula Vista Medical Center. “However, if you are experiencing painful sexual activity, don’t be afraid to ask for help. We are trained and experienced in treating sexual health, and it is likely something very simple to assess and treat.”

According to Dr. Carson, when you discuss painful sex, your doctor must first determine the location of your pain: is it vaginal or pelvic?

Vaginal pain
Common reports of painful sex often have to do with vaginal lubrication. In younger women, lubrication issues are more likely the result of not enough foreplay or not communicating their sexual needs to their partner; vaginal infection; or medications that can reduce sexual desire.

Vaginal lubrication issues for women in perimenopause, menopause or post-menopause are most often due to vaginal atrophy as a result of declining estrogen levels, which can be treated with oral or vaginal preparations. These treatments can be over-the-counter (OTC) lubricants, as well as prescription hormonal or nonhormonal medications.

Other causes of pain during sex due to lack of desire or arousal include:

• Mental health concerns, such as anxiety or past trauma

• Issues related to self-confidence or body image

• Fatigue or stress

• Relationship problems

• Medical conditions, such as arthritis, diabetes and cancer

• Scarring from past surgeries or episiotomy during childbirth

• Partner’s sexual health problems, such as erectile dysfunction, leading to shared anxiety and prolonged intercourse

Pelvic pain
Some common causes of pelvic pain during sex are positioning, pelvic infection, pelvic scarring or pelvic masses. Endometriosis — a condition in which the tissue that lines the uterus occurs outside of the uterus, leading to inflammation — affects roughly 1 in 10 women and is a common cause of pelvic pain during sex.

Pelvic pain is treated by diagnosing the source of the pain through a pelvic exam, ultrasound or laparoscopy — a procedure performed using a fiber-optic instrument to view your reproductive organs. Treatments can include medication, physical therapy or surgery.

7 steps for pain-free sex
The ACOG recommends the following seven at-home steps you can take to address pain during sexual activity:

• Use a water-soluble or silicone-based lubricant.

• Find quality time to be intimate with your partner, free of distractions or stress.

• Communicate with your partner — work to openly discuss concerns and preferences.

• Focus on alternate sexual and nonsexual activities that do not cause pain, such as intimate touching or massage.

• Use relaxation techniques — meditation, breathing, music, a warm bath — before engaging in sexual activities.

• Take OTC pain-relief medication, such as acetaminophen or ibuprofen, prior to sexual activity.

• Apply ice or a cooling pack to external irritated or painful areas after sexual activity.

Talk to your doctor if you are experiencing frequent pain during sexual activity. Your doctor can help determine if your pain is a gynecologic condition or related to sexual health.

“Your doctor is here to make sure all of your health needs are met, including sexual health,” Dr. Carson says. “Your sexual health is an important component of your total health.”

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