Coping with Sexual Pain

Having comfortable pain-free intercourse

Painful sex is a reality for about 10% of women. Dyspareunia (dis-pair-ee-ooh-nee-a) is the medical term for painful sex. Dyspareunia includes vaginismus, or problems with the pelvic, floor muscle that prevents penetration of the vagina; vulvodynia, or inflammation of the area around the entrance to the vagina; and conditions such as interstitial cystitis, repeated infections, and endometriosis.  Sometimes stress or past sexual trauma–or trauma of any kind, for that matter–contribute to painful sex, or make the perception of pain worse.   Women describe painful sex as intercourse feeling like sandpaper or even sharp knives in the vagina.  Understandably, this is a very difficult problem to endure when a woman is in  an intimate relationship where both she and her husband want to enjoy intercourse for its sense  of closeness.

Most women describe sexual pain as being frustrating, embarrassing, and even depressing.  Women sometimes wait a long time to address the problem, and once they do, it can take a long time before they get appropriate help.  In the meantime, the partner sometimes becomes depressed or withdraws both physically and emotionally.  Sometimes he is confused or angry; sometimes he simply doesn’t want to hurt his partner.

Painful sex is difficult to diagnose and to cure. Most often, painful sex is managed through a combination of medications such as hormones and topical ointments, and sometimes includes physical therapy. Sexual pain can also be managed through psychotherapy, specifically using techniques from health psychology and medical family therapy.  Some very simple suggestions that may actually help include:

  • Eliminating the use of harsh soaps, either for washing the body or intimate clothing items.
  • Using warm water–no soap–to clean the genital area.
  • Wearing cotton underpants.
  • Changing out of sweaty workout clothing, especially if synthetic, right after working out.
  • Using unscented feminine hygiene products
  • Cutting down caffeinated beverages

I am considered by sexual medicine specialists to be an expert in this area. I am a member of the International Pelvic Pain Society and Pelvic Floor / Sexual Medicine.  Management techniques include cognitive behavioral therapy, relationship therapy, stress and relaxation management and other interventions. If you are uncertain what other specialists to see, I can provide referrals to other healthcare providers for your treatment team.  In addition, if you have painful sex and have not had an adequate medical diagnosis and treatment, I can and will refer several specialists to help you.


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