Pain During Sex - WTF?!?

The medical term is dyspareunia, which means difficulty, discomfort, or pain during intercourse. It's a condition I see quite frequently in my clinic and while many people who experience this symptom cross their fingers and hope it will go away on its own, that's not the reality for everyone.

As confusing and frustrating as dealing with painful sex can sometimes be, I find there are only so many causes. If we work our way through the list we can typically get to the bottom of what's actually going on. In many cases I've seen my patients find relief and actually heal from experiencing pain during sex, I'll explain how.

Differentiating the discomfort

First things first, if we're going to get to the bottom of what's really going on then it's important to get clear about what exactly you're experiencing, because pain during sex can actually be caused by several different reasons, all of which may create different symptoms and sensations.

So before we get started, if you haven't already, give some thought to what exactly is going on. When do you experience the pain? Just during sex or afterwards too? Where do you feel it? Are there other symptoms you're experiencing? Is your menstrual cycle affected? Having a better handle on just what you're experiencing with help to hone in on what the cause is.

Potential causes

Some of the most common causes of pain during sex that I see are vaginal dryness, hormonal imbalances, fibroids/polyps/cysts, endometriosis, UTIs and bladder infections, HPV or herpes flare-up, Pelvic Inflammatory Disease, trauma, or in some cases the cause is totally unknown. Regardless of why the pain is happening, in the majority of these cases there are several treatment options that can help you get painfree.

Vaginal dryness + hormonal imbalances

I group these two together because they often go hand and hand. Even if dryness isn't overtly obvious, imbalances of hormones and deficiency of estrogen can throw off the environment of the vagina and cause not just dryness but also thinner and more sensitive vaginal walls that may have increased sensation or become easily irritated.

Hormonal imbalances and dryness can affect how comfortable insertion is, and in some cases even external stimulation of the clitoris may feel sensitive. In some cases lubrication helps, but in others it doesn't. Especially if the vaginal walls are thin, they can become really irritated by sex and cause pain long after which may feel like burning, itching, or sharp pain around the vagina or vulva.

If you feel this is the case for you, check out my post: Let's Talk About Vaginal Dryness. I especially recommend acupuncture and herbal medicine for this condition, because it helps to reduce sensitivity right away and focuses on treating the root of the issues, the hormonal imbalance.

Fibroids, polyps + cysts

Any growth in the uterus, cervix, or vagina has the potential of causing pain during sex, especially if large or located close to the cervix or in the vagina.

Fibroids can occur anywhere in the uterus and in some cases may protrude into the vagina. They are typically accompanied by heavy menstrual bleeding and cramping. Polyps occur along the uterine lining inside of the uterus and may cause pain and irregular bleeding or spotting between cycles, but may cause no other symptoms. Cysts typically form on the ovaries for a number of different reasons, if inflamed it may radiate pain throughout the lower abdomen during sex. In some cases cysts can also occur on the uterus or vagina and cause pain.

Depending on where they are located they may cause pressure or fullness in the abdomen, a poking feeling, cramping, dull pain, or a stabbing pain.

All of these growths are typically benign and may even resolve on their own, but if they don't and they grow large enough then it may be recommended to have them surgically removed. In some cases fibroids very close to the cervix can't be safely removed without effecting the competency of the uterus, in which case using acupuncture and herbal medicine to improve circulation, manage pain, and potentially even shrink existing fibroids or prevent more from forming.

Endometriosis

This is a condition where the uterine lining migrates outside of the uterus and adheres to other organs, such as the bladder or bowel. When the lining sheds during the period, it sheds in these locations too, causing inflammation and pain far wider and more intense than during an average period.

Endo usually causes the most pain during the period, when cramping is typically severe and bleeding may be heavy. It's also known for causing adhesions in the abdomen, where it can glue two different tissues together, such as the bladder to the uterus, or the uterus to the bowels. If these adhesions are present they can definitely cause pain during sex depending on where and how they form.

The only true way to find out if you have endometriosis or if it's caused adhesions is through laparoscopic surgery, so usually other tests are performed first and if endometriosis is suspected then surgery may be scheduled to check for and, if necessary, clean up the endometriosis. If you think you may have endometriosis, see an OBGYN, gynecologist, or uterine specialist to discuss screening and treatment options.

Urinary Tract Infections & Cystitis

Urinary Tract Infections are more common in women than men because the female body has a shorter urethra, and UTIs are especially common after sex.

If you notice burning pain during urination, pressure in the low abdomen, or changes to your urine such as cloudy urine or the presence of blood, those are all red flags for a UTI or possibly even a bladder infection, known as cystitis. If this is the case it's important to get treatment right away, because if infection moves into the kidneys it can be incredibly dangerous.

Generally UTIs can be avoided by staying hydrated, peeing frequently (especially after sex,) and keeping your immune system strong, but some people tend to be more prone to them than others. If you get frequent UTIs, especially if you seem to be unresponsive to antibiotics, then it's important to really focus on supporting and improving your immune system. In that case, I highly recommend acupuncture and herbal medicine, as well as taking a look at diet, adding in plenty of fermented foods or possibly supplementing probiotics.

HPV or Herpes flare-up

A flare-up of HPV or herpes can obviously cause pain during sex if sores are present on the vulva, they usually cause a lot of sensitivity or pain that may leave you feeling very little desire for sex. But an outbreak of sores and warts can also develop on the cervix or other internal locations where they cause pain during sex but aren't outwardly visible.

Especially when pain seems to be located deep inside and becomes irritated with insertion, that could be a sign that the cervix is sensitive or inflamed. If you're due for an STI test or a Pap smear, get tested to rule herpes or HPV out. Luckily these flare-ups are usually fairly easily treated with anti-viral medication and in some cases may even clear up on their own.

Pelvic Inflammatory Disease

This is a condition that occurs secondarily to other untreated infections, such as chlamydia, gonorrhea, HIV, or other instances of bacterial infections of the uterus.

PID causes pain and pressure in the lower abdomen because the reproductive organs are swollen and inflamed. It typically involves vaginal discharge, possibly with a foul smell, but in some cases the symptoms are mild enough they go unnoticed. Once PID is identified, it's usually quite easy to treat with antibiotics and usually clears up quickly.

Trauma

It is incredibly common for survivors of trauma - sexual or otherwise - to experience pain or discomfort during sex.

Trauma can mean one isolated traumatic experience or sustained trauma experienced over a long period of time. In some cases sexual symptoms happen right after the trauma is experienced, in some cases there is a delayed reaction, in some cases experiences don't register as traumatic until long after they happened.

The symptoms of trauma-induced pain during sex can be the most diverse and in some cases confusing compared to other conditions. The quality or location of the pain may stay the same or change. Sometimes pain might not be an issue but other times it is. The pain can also induce strong emotions or in some cases flashbacks of traumatic situations.

I find therapy to be a key component of healing trauma, whatever that means for you. There are several different types of therapies and therapeutic activities that may be effective for you, talking therapy may or may not be one of them.

I often recommend acupuncture as part of treatment as well, because it has the ability to affect several different aspects of trauma all at once, for example calming the nervous system, reducing anxiety, stopping pain, increasing circulation, and releasing trapped trauma from the physical body.

Unknown Cause

Sometimes pain during sex starts for no known reason and even after all the examinations and soul searching, we can't find any logical reason for why the pain continues. In cases like these acupuncture is especially helpful because it's able to treat patterns that can be identified via unconventional diagnostic means and therefore can treat conditions that are confusing or mystifying according to Western medicine.