FYI, the technical term for painful sex is dyspareunia. This can refer to any type of pain – sharp, dull, aching, burning, friction – and vary in intensity. The repercussions go beyond the bedroom, says GP and sex therapist Dr Rosie King, who explains that painful sex can lead to a loss of self-confidence, anxiety and depression, plus relationship issues. “Don’t just ignore the pain and hope it will disappear. It needs to be treated.” But before that, it’s crucial to work out what’s driving the ouch.
What causes painful sex?
1. LACK OF LUBRICATION
“This could be because you’re not ‘turned on’ enough, or due to hormonal changes during breastfeeding,” explains King. “Menopause can also cause dryness and fragility of the vaginal lining.”
2. PRIMARY VAGINISMUS
“This is when sex has always been painful or unsuccessful,” explains Matty Silver, sex therapist, counsellor and author of Sex Down Under (New Holland Publishers, $29.99). “The muscles around the vaginal canal go into a spasm ... making [sex] virtually impossible.”
3. SECONDARY VAGINISMUS
You’ve had pain-free intercourse in the past, but then the vaginismus is triggered by something. “It could be a difficult childbirth, recurrent vaginal infections, low sexual desire, a sexual assault or endometriosis,” says Silver. Hard statistics on vaginismus are tricky to come by, as women often suffer in silence, but estimates suggest it impacts between five to 17 per cent of us.
Thought to affect between four and eight per cent of women at any one time, this refers to pain, burning and discomfort at the opening of the vagina that can’t be linked to a cause. “It can be so uncomfortable that sitting for long periods, using tampons or having sex is difficult or even impossible,” adds Silver.
5. A HEALTH CONDITION
What can you do to stop pain during sex?
Your move now? Get the right diagnosis before trying any self-help treatments. “Visit your GP as a starting point,” advises King. “They will refer you to the appropriate professional, which could be a gynaecologist, a vulval dermatologist, a urologist, a gastroenterologist, a physiotherapist or a psychologist, relationship counsellor or sex therapist.” Sounds overwhelming, we know, but the point is: you have options and there’s a whole squad out there to help you.
Here’s what you can expect from the major players:
1. A PELVIC PHYSIOTHERAPIST
...can help with issues such as vaginismus and vulvodynia. “The pelvic floor is a muscle like any other and if it’s overactive [doesn’t lengthen adequately or have
enough flexibility] then sex, or using a tampon or having a pap smear hurts,” says Angela James, principal physiotherapist at the Sydney Pelvic Clinic. “The role of the pelvic physio is to educate you, make you aware of these muscles and retrain them.” Most patients have their issues resolved within six to 12 weeks. Treatment involves using vaginal trainers or dilators internally, and working on trigger points – as well as your mind and nervous system – to help break the pattern of ‘tensing up’ when you anticipate pain.
2. A SEX THERAPIST OR RELATIONSHIP COUNSELLOR
...can help with low libido, stress and anxiety around painful sex. “We have the time to ... explain and explore your [situation], and we can also see your partner to help them understand the problem,” says King. These experts can also help delve into psychological factors, such as sexual trauma or relationship issues. Sidenote: a sex therapist who is also a medical doctor can usually make a diagnosis and refer you to a physio or gynaecologist, if needed.
3. A GYNAECOLOGIST
...can help with medical diagnosis and treatments. These guys can treat underlying causes of painful sex, such as STIs, hormonal changes, endometriosis, cysts, pelvic inflammatory disease and issues from vaginal childbirth.
4. DIY TREATMENT
...can help with insufficient lubrication and while you’re waiting for longer-term treatment. “Try engaging in longer foreplay, kissing, cuddling, massages, mutual masturbation, oral sex and using a lubricant,” suggests Silver. “I also believe the best position for a woman is to be on top. You are then in charge and can be very careful and can stop when it becomes painful.” Top that.
How to talk about it
1. WITH YOUR PARTNER
“Take the time to talk it through so they can understand you aren’t rejecting them,” says King. “Tell them ‘It’s not you – it’s the pain that is the problem.’”
2. WITH YOUR DOCTOR
Be as descriptive as possible: do you have pain at certain times of the month, or is only during sex? Has it gotten worse recently or have you always had it? This will help them refer you in the right treatment direction. “If you have difficulties telling your male GP, ask for a female one,” says Silver.