Almost every woman experiences discomfort during sex at some point in her life. But many suffer in silence for years because they’re embarrassed to ask for help or because they’ve been told it’s all in their heads. While sexual pain can be a symptom of stress, depression, or some other psychological problem, there are a number of physical conditions to rule out before heading for the therapist’s couch. See if any of the following describes your problem.
Sometimes pain during sex is the first sign of an infection. Vaginal yeast and bacterial infections can reduce lubrication and irritate the opening of the vagina, and will usually be accompanied by itching or an unusual discharge or odor. A urinary tract infection will hurt most when you urinate but can also cause pain during sex because of the pressure on a tender, inflamed bladder. Abdominal pain with intercourse may be a symptom of the sexually transmitted disease chlamydia. Left untreated, chlamydia can lead to pelvic inflammatory disease, which causes inflammation and scarring that can make sex unbearable. Once diagnosed, most infections are easily treated with antibiotics or, in the case of yeast, antifungal creams or pills.
About 5 million American women have this painful condition in which tissue from the lining of the uterus grows into areas outside of the uterus such as the vagina or pelvis where it becomes inflamed. More than half of these women report pain with intercourse. Endometriosis can usually be treated with drugs that temporarily suppress estrogen production or surgery to remove the wayward tissue. Birth control pills can also help. Using the woman-on-top position or limiting intercourse to the week or two after you menstruate may also minimize the discomfort.
When you feel as if you have a urinary tract infection, but antibiotics won’t make it go away, the problem is probably interstitial cystitis. Experts don’t know what triggers this condition, in which your bladder becomes chronically inflamed, leading to severe pelvic pain that tends to worsen during sex. Like vulvodynia, this condition is difficult to diagnose and treat. Sufferers may find relief from one of a variety of treatments, such as the drug Elmiron, but no single therapy seems to work for everyone. The woman-on-top position may help you avoid the discomfort that comes with deep penetration.
If burning pain at the opening of the vagina has made sex impossible but your doctor can’t find a cause, you may have vulvodynia, a condition in which part of the vulva is chronically inflamed. No one knows how many women suffer from it or what first sets off the pain, which may be a constant torture or may flare up just during sex. Experimental treatments include cutting certain foods out of your diet or learning to use a biofeedback device to control muscle spasms that may be contributing to the pain. Surgery to remove the inflamed skin has resolved the problem for some women, but should be considered only as a last resort.
If you’re breastfeeding or approaching menopause, your sexual discomfort may be due to hormonal changes. In both cases, falling estrogen levels can dry up your natural lubrication and make your vaginal tissue fragile. New moms may want to use a drugstore lubricant until their estrogen levels return to normal when they stop breastfeeding. Older women with this complaint may consider going on hormone replacement therapy or using an estrogen cream.
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