What Women Need to Know About Pain During Sex

CS-Blog

Cedars-Sinai Blog

Sep 12, 2018
Cedars-Sinai Staff

Pain during sex is a common problem for women.

As many as 75% of women will experience pain during sex at some point, according to the American College of Obstetricians and Gynecologists. For many women, the pain is rare or happens only once, but for others it’s persistent.

“Some women may have experienced sexual joy, but then at some point in their life, it becomes painful,” says Dr. Karyn Eilber. “They may stop having sex with their partners. Whether your pain is mild or severe, if it bothers you and it’s inhibiting you from having sex, you should definitely talk to you doctor. “

Dr. Eilber and Dr. Alexandra Dubinskaya treat women with sexual dysfunction and study its causes. Here’s what they think women should know about painful sex:

“Like mental health, sexual health can carry a stigma. Mental health is slowly losing that stigma, and sexual health needs to follow that trend. We can look at these things as health conditions and normalize having these conversations as part of our regular healthcare.”

Sex isn’t supposed to hurt

Sexual health is worth prioritizing

Read: How to Address Uncomfortable Topics With Your Doctor

Dryness is a common cause of pain during sex

Read: Endometriosis Q&A with Dr. Kelly Wright

Many conditions may cause pain during sex

Dryness is the most frequent reason, but there are many other reasons sex might become painful. Some conditions that can be at the root of the problem:

• Endometriosis: In people with endometriosis, the tissue that normally lines the uterus grows in other areas of the pelvis, such as the ovaries, fallopian tubes, or intestines. The condition can be painful, including causing pain during sex.
• Interstitial cystitis: Also known as painful bladder syndrome, this condition is often mistaken for a urinary tract infection because it shares many of the same symptoms such as bladder and pelvic pain, pressure, and a frequent urge to urinate. However, the condition is not an infection.
• Pelvic floor dysfunction: The pelvic floor muscles—the ones you tighten when you want to stop passing urine quickly—can become painfully tight. It can cause an achy pelvis and pain with any kind of insertion.
• Pelvic floor injury: An injury to the pelvic floor, which can have many causes from vaginal childbirth to improperly fitted bicycle seats, can cause pain during sex.  
• Vaginismus: The muscles at the opening of the vagina become tightly contracted, making penetration impossible.
• Vulvodynia: Chronic pain at the opening of the vagina, including burning, stinging, soreness, itching, rawness and pain during sex.
• Infections: Bacterial, yeast or sexually transmitted infections can cause pain during sex and usually have other symptoms, such as discharge.
• Ovarian cysts: These fluid-filled sacs on the ovaries often have no symptoms. When they rupture, they can cause pain and bleeding.
• Fibroids: These non-cancerous growths on the uterus can cause heavy menstrual bleeding, pelvic pressure, pain, and painful intercourse.

Read: Polycystic Ovary Syndrome Q&A with Dr. Jessica Chan

Don’t suffer in silence

Painful sex usually has a cause, and once it’s identified, it’s likely treatable. If you’re avoiding sex, it’s time to see your doctor. Your gynecologist is often the best place to start, as they’re likely to be able to accurately diagnose the cause of the pain. 

Many women are reluctant to talk about any issues they’re having in the pelvic region, whether it’s a prolapse, incontinence or painful sex. Many don’t open up to friends or loved ones about these issues, and as a result, these problems seem kind of mysterious to the average person.

“I think as women, we often tend to blame ourselves,” Dr. Eilber says. “That can definitely contribute to the pain and to sexual dysfunction. I think the more resources we can make available, and the more we’re able to talk openly about these issues, the more beneficial it will be.” 

Read: Reclaiming the Joy of Sex

Dyspareunia – Painful Sex | familydoctor.org

What is dyspareunia?

Dyspareunia is painful sex for women. Also, it causes pain during tampon use. The pain can be felt in a woman’s genitals or deep inside her pelvis.

Symptoms of dyspareunia

The pain may feel sharp, burning, or like menstrual cramps. Pain during sex may feel like it is coming from deep inside the pelvis. Women often report the feeling that something is being bumped into inside them.

Dyspareunia can have many causes, including.

• Infection (such as a yeast infection, urinary tract infection)
• Injury to the vagina
• Inflammation of the vagina. The inflammation can be so bad that wearing pants can cause pain.
• Poorly fitted diaphragm or cervical cap. These are methods of birth control.
• Muscle spasms around the vagina. For some women, the pain of the spasms is so severe that sexual intercourse is impossible.
• Vaginal dryness. This dryness may be caused by menopause and changes in estrogen levels. Estrogen is a hormone. It could also be from a lack of foreplay before intercourse.
• Abnormalities inside the uterus. These could include fibroid growth, if the uterus is tilted, or if the uterus prolapses (falls) into the vagina.
• Certain conditions or infections of the ovaries
• Past surgeries. This may leave scar tissue that can cause pain.
• Endometriosis (scar tissue outside the uterus unrelated to surgery)
• Pelvic inflammatory disease
• Being tense during sex or being unable to become aroused

How is dyspareunia diagnosed?

During a visit with your doctor, they will ask you to describe your pain, where it is located, and when it began. They may also ask you to describe what you have tried in the past to relieve the pain. For example:

• Have you tried a sexual lubricant or more foreplay?
• Is it painful every time you try to have sex?
• Are there other problems associated with sex?

Your doctor may want to examine your genital area or perform a pelvic exam. During a pelvic exam, your doctor may apply a cotton-tipped swab to the area around the vagina to see if it is painful. Your doctor will examine your vagina and cervix using a tool called a speculum. This helps the doctor gently open the area for the exam. It is similar to the way you get a Pap smear. For some women, this part of the exam may be painful. Your doctor may use a smaller speculum to decrease the discomfort. Your doctor may also delay the exam until the pain has decreased. It is important to let your doctor know if the exam becomes too painful.

During the final part of the exam, your doctor will feel your uterus and ovaries with one hand on the abdomen and finger(s) in your vagina. This is similar to exams performed during a pelvic exam.

If your symptoms and exam suggest an infection, your doctor may take a sample from your vagina or cervix to send to the lab. A urine test is another possible test. Your doctor may order a pelvic sonogram, CT (computed tomography), or X-ray test to look inside your pelvis.

Can dyspareunia be prevented or avoided?

Depending on the cause of your dyspareunia, it could be prevented through treatment. For example, if it is caused by vaginal dryness or lack of foreplay, it can be prevented through the use of a sexual lubricant.

Dyspareunia treatment

Treatments depend on what is causing your pain. They may include sexual lubricants (over-the-counter products), antibiotics for infections, a different type of birth control, or surgery.

Living with dyspareunia

Living with dyspareunia may be physically uncomfortable. However, it may affect your sexual relationship as well. Anticipating pain during sex may cause you to avoid it. It may change the type of birth control you use (which may or may not be convenient for you).

Questions to ask your doctor

• Could tampon use or overuse be causing my pain?
• Does childbirth cause the pain?
• Can hormone replacement therapy (HRT) help vaginal dryness?
• Can the pain be related to ovarian or cervical cancer?

Resources

Office on Women’s Health, U.S. Department of Health and Human Services: Reproductive Health

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Self-harm: what it is, causes, diagnosis, treatment

What is self-harm, why do people deliberately hurt themselves, when self-harmful behavior can be masked as the norm and how to get rid of self-harm, says psychologist Alena Vanchenko

Self-harm is aggression directed at oneself, which manifests itself in various forms of self-harm. This behavior is also referred to as self-aggression. Most often, selfharm is associated with cuts, bumps or burns. However, self-harm is not limited to them. Neuropsychologist, psychotherapist and lecturer of the Synchronization project Alyona Vanchenko explains what underlies self-harmful behavior, how it manifests itself, what it refers to self-harm, what types of it can even be considered culturally acceptable and how to help a person who harms himself.

When it comes to self-harm, there are two important problems that practitioners face. The first is the lack of high-quality statistics in Russia. In our country, few people talk about self-harm, unlike, for example, the USA, Canada and European countries. According to official data from these countries, almost 27% of teenagers and 5% of adults have or have experienced some form of self-harm (cuts, burns, bumps, hair pulling, extreme hot showers, preventing scars from healing, substance use, etc.).

The second is the absence in the International Classification of Diseases (ICD) of a single article describing self-harm. More often, such behavior is mentioned as one of the accompanying symptoms of the disease – personality disorders, addictions, or, for example, eating behavior. Because of this, in people’s minds, self-harm is very strongly associated with serious mental disorders. However, episodes of self-harm occur both in people with disorders and in mentally healthy people.

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Types of self-harm

There are three types of auto-aggressive behavior: suicidal, non-suicidal, and “accidental” self-harm.

Suicidal self-harm is not just a desire to harm yourself, but a desire to end everything that is happening here and now. It most often manifests itself in people in adolescence or in a midlife crisis, for example, in depressive states. The non-suicidal form of self-harm is often expressed in the desire to hurt oneself, inflicting cuts and wounds on oneself. Sometimes it is confused with suicidal manifestations, believing that if a person cuts his hands, he wants to commit suicide. But the essence of non-suicidal self-harm, on the contrary, lies precisely in causing pain to oneself, and not in the desire to stop it, as well as in control over one’s own body.

Also, non-suicidal self-harm can be accompanied (or hidden behind) the use of certain substances – from alcohol, drugs and nicotine to dietary supplements. The latter, for example, is characteristic of orthorexia, a form of eating disorder when a person is obsessed with the idea of ​​a healthy lifestyle and severe food restrictions. Or, for example, when people “swing” their muscles in the gym to abnormal states – this is also a form of auto-aggression.

Subconscious self-harm

The last type – “accidental” self-harm – can occur in situations where a person does not understand what he is doing, but his inner drive to inflict physical harm on himself manifests itself unconsciously. That is, this is not a “crime by negligence” when a person accidentally cuts himself or somehow harms himself. This is a subconscious desire to hurt yourself – for example, due to psychological trauma.

Such “accidental” self-harm can also include a generally culturally acceptable phenomenon, such as losing weight or gaining weight. For example, if a woman has experienced physical or emotional abuse, she may unconsciously change her eating behavior and begin to gain weight, associating the trauma with her appearance and believing that in this way she will lose her attractive shape and this will never happen to her again.

It is important to understand that even if the self-aggression itself is not suicidal, the consequences of self-harm can be the most serious – self-destructive behavior often serves as the first wake-up call, signaling problems with mental health.

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Causes and triggers of self-harm

So why do people cut themselves, injure themselves, lose weight extremely, and torture their bodies in other ways? All self-harm methods are an attempt to maintain control. When a person loses control over life in its various manifestations, feels lonely and does not feel stable, the only thing left that he thinks can be controlled is his body. Auto-aggression as a psychological defense allows you to relieve stress, shift the focus from the lack of control over the life situation: “This is my choice – to take an extra load in the gym. It’s my choice not to eat all day. It’s my choice to hurt myself.”

People who suffer from eating disorders, such as anorexia or bulimia, very often respond to the fears of loved ones that they have everything under control. And in this case, self-harm can be a manifestation of obsessive-compulsive disorder. Autoaggression, in principle, often manifests itself not only with OCD, but also with other diseases – depressive disorders, borderline personality disorder, bipolar personality disorder.

Self-harm and personal crisis

Healthy people can also begin to harm themselves against the background of depressive conditions or life crises. It is impossible to say for sure that one person is prone to self-harm and the other is not. But we do know that some triggers trigger self-harm—anxious emotions, feelings of isolation, relationship difficulties, social pressure, and difficulties at school or work.

The risk of self-harm increases during periods of life when suicidal tendencies are on the rise, such as during adolescence. This is a time of sharpening character traits, a time of behavioral disorders – and therefore among people who engage in self-harm, we often see teenagers.

But this does not mean that self-damaging behavior cannot begin in adulthood – people who are experiencing age-related and existential crises are also at risk. For example, when a person loses his life’s work or earnings, experiences a difficult divorce or the death of a loved one, he experiences a terrible internal, existential crisis. The experience of grief is very often associated with self-harm – it seems that you are just a pawn in the huge chaos of life, and you need to deal with it somehow. This is how stories appear when a person who has lost his business begins to live in a gym, take anabolics and steroids and frankly harm his body. But no one sounds the alarm, because a person is engaged in sports, what is wrong here.

In group therapy, the patient sees that he is not alone (Photo by Getty Images)

Ways of treatment

Everything is very individual here and depends on what led the patient to self-harm. Researchers at the Melbourne Institute identify several strategies for helping people with self-injurious behavior: through wanting to help oneself, distraction, feeling connected to others, creating a support group, making changes in areas of life, and replacing self-harm with healthy control mechanisms.

To cope with self-harm, it is best to consult a specialist – a psychotherapist or psychiatrist. Self-harm is the deviation in which a person needs a person: they need the ability to control their relationships with other people and with themselves. Therefore, one of the best practices that help people with auto-aggressive manifestations is group therapy and group anonymous meetings. In group therapy, the patient sees that he is not alone, that other people experience the same thing, share it freely and overcome self-harm.

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If your loved one or friend suffers from self-harm, it is first of all important to understand that, as in addiction stories, he must want to get help himself. Imposed help is bad help, it will only cause aggression. You can start with soft intervention. During it, close people get together and broadcast to a person showing destructive behavior, complicity and empathy: it is important that the person is not attacked, but told how they love him and see what is happening to him, how they are afraid to lose him. At such an intervention, friends and loved ones share how the person’s condition has affected their lives and what they want for him.

The main goal of the process is to stir up the person emotionally, to show that there is another way. It is desirable that a therapist or psychiatrist be present during the intervention, who will help to conclude a “contract” – to agree with the person that at the end of the conversation he will leave for the clinic to undergo therapy and receive help. If a child suffers from self-harm, then the parent can refer him to a psychiatrist in order to work out a systematic treatment and begin active assistance.

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When a baby scratches and slaps himself, this is normal, because he knows his body in space and is still learning coordination. When a preschooler beats, bites and pinches himself, he either tries to express an internal contradiction, or feels guilty, or manipulates his parents.

If the parents did not teach the child to properly express emotions and cope with emotions, but, on the contrary, scolded, severely suppressed needs, forbade him to show feelings, then he comes to school with a well-formed habit of “discharging” through auto-aggression. That is, aggression directed at oneself, manifested in various types of harm to one’s body.

The feeling of uselessness, the need to punish oneself, inner emptiness, self-hatred, the desire to reduce emotional experiences – this is the main list of reasons for self-harm.

Simply put, mental pain leads to physical pain

By hurting oneself, a person temporarily drowns out inner pain, but does not get rid of its cause. And often such people are mentally healthy, and their actions are a way to feel better. A significant number of people who inflict self-harm experienced abuse in childhood and now continue to punish themselves through their own actions (“I am bad, this is how I should be treated”).

It should be noted that self-harm is not related to gender, age or social status. Everyone can be exposed to them – both ordinary schoolchildren, and successful men, and pensioners.

Signs of self-harm

The term “self-harm” or “non-suicidal self-harm” has now been introduced. This behavior includes a wide range of activities:

• hair pulling,

• hitting,

• cutting,

• scratching the skin,

• burns,

• complete refusal of water and / or food),

• hurting yourself with the help of others – jumping under a slow moving car, teasing a stray dog,

• using psychoactive substances – this is also harmful to health.

A number of Russian psychiatrists believe that tattoos also refer to intentional injuries and, depending on the age at which they were made, on the location and semantic load, they can determine the degree of a person’s psychological trauma. Although in Europe, body modification (tattoos and piercings) do not belong to self-harm.

How to help someone who practices self-harm

If you notice damage to your loved one (any of the above or similar), then choose the right time and try to talk to him. Without judgment, with respect for his personality, as correctly as possible. In a conversation, it is worth excluding categoricalness, exactingness and pressure, because he is just running from this. Show him that you are ready to help and support.

If a loved one can share his accumulated emotions with you, then a start has been made. Prepare him for the fact that in order to solve this problem, it is necessary to contact a specialized specialist.