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

Female Pain During Sexual Intercourse (Dyspareunia): Causes & Treatments

Written by WebMD Editorial Contributors

• What Causes Painful Sex in Women?
• How Can Painful Sex In Women Be Treated?

Intercourse pain, or dyspareunia, can cause problems in a couple’s sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant.

In some cases, a woman can experience painful sex if one of the following conditions is present:

• Vaginismus. This is a common condition. It involves an involuntary spasm in the vaginal muscles, sometimes caused by fear of being hurt.
• Vaginal infections. These conditions are common and include yeast infections.
• Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.
• Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.
• Endometriosis. This is a condition in which the tissue similar to that which lines the uterus grows outside the uterus.
• Problems with the ovaries. Problems might include cysts on the ovaries.
• Pelvic inflammatory disease (PID). With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.
• Ectopic pregnancy. This is a pregnancy in which a fertilized egg develops outside the uterus.
• Menopause. With menopause, the vaginal lining can lose its normal moisture and become dry.
• Intercourse too soon after surgery or childbirth.
• Sexually transmitted diseases. These may include genital warts, herpes sores, or other STDs.
• Injury to the vulva or vagina. These injuries may include a tear from childbirth or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.

• Vulvodynia. This refers to chronic pain that affects a woman’s external sexual organs — collectively called the vulva — including the labia, clitoris, and vaginal opening. It may occur in just one spot, or affect different areas from one time to the next. Doctors don’t know what causes it, and there is no known cure. But self-care combined with medical treatments can help bring relief.

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.

Some treatments for female sexual pain do require a doctor’s care. If vaginal dryness is due to menopause, ask a health care professional about estrogen creams or other prescription medications. Other causes of painful intercourse may also require prescription drugs.

For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding past abuse.

Call a doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. Ask for a referral to a certified sex counselor if there are other concerns that need to be addressed.

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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.

Selfharm: why people hurt themselves physically and how to help them

Know YourselfA Man among People

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he knows his body in space and is still learning to coordinate. 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 feelings, 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 lessen emotional experiences – this is the main list of reasons for self-harm.

Simply put, mental pain leads to physical pain

By harming 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. The most comfortable way to start is with cognitive behavioral therapy. Understanding the causes of self-harm, working through them, reducing stress reactions, reducing the sensitivity of triggers – all this will lead to an improvement in the quality of life.