What are the common causes of painful intercourse in women. How can dyspareunia be diagnosed and treated effectively. When should you seek medical help for pain during sex. What lifestyle changes can help alleviate discomfort during sexual activity.

What is Dyspareunia and How Common is It?

Dyspareunia, the medical term for painful intercourse, is a surprisingly common issue affecting many women. According to the American College of Obstetricians and Gynecologists, up to 75% of women may experience pain during sex at some point in their lives. For some, this pain may be a rare or one-time occurrence, while for others, it can be a persistent and distressing problem.

Dr. Karyn Eilber, an expert in the field, notes: “Some women may have experienced sexual joy, but then at some point in their life, it becomes painful. They may stop having sex with their partners.” This highlights the significant impact dyspareunia can have on a woman’s quality of life and relationships.

Breaking the Stigma: Why Talking About Sexual Health Matters

One of the biggest challenges in addressing dyspareunia is the stigma surrounding sexual health issues. Many women feel embarrassed or ashamed to discuss their concerns, even with healthcare providers. However, experts emphasize the importance of normalizing these conversations.

As Dr. Eilber points out, “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.”

Overcoming Barriers to Seeking Help

• Recognize that sexual health is an integral part of overall well-being
• Understand that healthcare providers are trained to discuss these issues professionally
• Remember that seeking help is a sign of strength, not weakness
• Consider bringing a trusted friend or partner for support during appointments

Common Causes of Painful Intercourse: From Dryness to Medical Conditions

Dyspareunia can have various causes, ranging from simple issues like vaginal dryness to more complex medical conditions. Understanding these potential causes is crucial for proper diagnosis and treatment.

Vaginal Dryness: A Leading Culprit

Insufficient lubrication is one of the most common reasons for pain during sex. This can be caused by factors such as:

• Hormonal changes, particularly during menopause
• Certain medications, including some antidepressants and antihistamines
• Lack of arousal or foreplay
• Stress and anxiety

Medical Conditions Associated with Dyspareunia

Several underlying health issues can contribute to painful intercourse:

1. Endometriosis: A condition where uterine tissue grows outside the uterus, often causing pelvic pain and discomfort during sex.
2. Interstitial cystitis: Also known as painful bladder syndrome, this condition can cause pelvic pain and pressure.
3. Pelvic floor dysfunction: Overly tight pelvic floor muscles can lead to pain with penetration.
4. Vaginismus: Involuntary contraction of vaginal muscles, making penetration difficult or impossible.
5. Vulvodynia: Chronic pain or discomfort around the opening of the vagina.
6. Infections: Bacterial, yeast, or sexually transmitted infections can cause pain and other symptoms.
7. Ovarian cysts: While often asymptomatic, ruptured cysts can cause pain and bleeding.
8. Fibroids: Non-cancerous growths in the uterus that can cause pelvic pressure and pain during intercourse.

Diagnosing Dyspareunia: What to Expect During a Medical Evaluation

If you’re experiencing pain during sex, it’s essential to seek medical advice. A thorough evaluation can help identify the underlying cause and guide appropriate treatment.

Steps in the Diagnostic Process

• Detailed medical history, including sexual health history
• Physical examination, which may include a pelvic exam
• Laboratory tests to check for infections or hormonal imbalances
• Imaging studies like ultrasound or MRI, if necessary
• Referral to specialists, such as a urogynecologist or pelvic floor therapist, if needed

Can painful intercourse be a sign of a serious condition? While many causes of dyspareunia are treatable and not life-threatening, persistent pain should always be evaluated by a healthcare provider to rule out more serious underlying conditions.

Treatment Options: Addressing Pain and Restoring Sexual Health

The treatment for dyspareunia depends on its underlying cause. Here are some common approaches:

Lifestyle Changes and Self-Care

• Using water-based lubricants to reduce friction
• Practicing relaxation techniques to reduce anxiety
• Experimenting with different sexual positions
• Engaging in longer foreplay to ensure proper arousal

Medical Interventions

• Topical estrogen creams for vaginal dryness related to menopause
• Antibiotics or antifungal medications for infections
• Pain medications or muscle relaxants in some cases
• Hormonal treatments for conditions like endometriosis

Physical Therapy and Counseling

• Pelvic floor physical therapy to address muscle tension
• Sex therapy or couples counseling to address psychological factors
• Cognitive-behavioral therapy for anxiety or trauma-related issues

How long does it typically take to see improvement in symptoms? The timeline for improvement can vary widely depending on the underlying cause and chosen treatment. Some women may experience relief within a few weeks, while others may require several months of treatment.

The Importance of Partner Communication in Managing Dyspareunia

Dealing with painful intercourse can strain relationships, making open communication with partners crucial. Here are some strategies for fostering understanding and support:

• Educate your partner about dyspareunia and its impacts
• Discuss alternative forms of intimacy that don’t cause pain
• Involve your partner in treatment decisions when appropriate
• Consider couples counseling to address relationship challenges

How can partners best support someone dealing with dyspareunia? The most important thing is to be patient, understanding, and willing to explore non-painful forms of intimacy. Avoid pressuring for sexual activity and be open to trying new approaches recommended by healthcare providers.

Preventing Dyspareunia: Proactive Steps for Sexual Health

While not all causes of painful intercourse can be prevented, there are steps women can take to reduce their risk:

• Practice good hygiene to prevent infections
• Use protection during sexual activity to avoid STIs
• Maintain a healthy lifestyle, including regular exercise and stress management
• Address any pelvic floor issues promptly
• Stay hydrated and use lubricants as needed
• Attend regular gynecological check-ups

Can certain exercises or techniques help prevent dyspareunia? Pelvic floor exercises, also known as Kegel exercises, can help strengthen and relax the pelvic floor muscles, potentially reducing the risk of pain during intercourse. However, it’s important to perform these exercises correctly, so guidance from a healthcare provider or pelvic floor therapist may be beneficial.

The Future of Dyspareunia Treatment: Emerging Research and Therapies

As awareness of sexual health issues grows, so does research into new treatments for dyspareunia. Some promising areas of study include:

• Novel drug therapies targeting specific pain pathways
• Advanced pelvic floor rehabilitation techniques
• Regenerative medicine approaches, such as platelet-rich plasma therapy
• Improved diagnostic tools for more accurate identification of underlying causes

What role might telemedicine play in the future of dyspareunia treatment? Telemedicine has the potential to increase access to sexual health specialists and provide discreet, convenient follow-up care. While initial evaluations may still require in-person visits, virtual consultations could help with ongoing management and support.

In conclusion, dyspareunia is a complex but treatable condition that affects many women. By breaking down stigmas, seeking proper medical care, and exploring various treatment options, women can reclaim their sexual health and well-being. Remember, pain during sex is not normal, and help is available. If you’re experiencing discomfort, don’t hesitate to reach out to a healthcare provider for guidance and support.

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.