It’s So Painful, We Just Stopped Having Sex - the young version.
As promised, this one is for Gen X and below. Let’s talk painful sex in the menstrual aged crowd. While atrophy is rarely a problem in this group, the thing that the two ages do have in common is that if you keep trying to have sex when it hurts, the original reason for the pain won’t matter because the body will develop such a negative response to sex that you will have worse and worse problems. So, if it hurts and doesn’t get better, get to the doctor. Below, we will detail some of the underlying causes.
Endometriosis - an inflammatory condition of the pelvis caused by growth of endometrial tissue outside of the uterine cavity. Where you have pain is determined by the location of the endometriosis and the extent of the inflammatory reaction. To start, most women only have pain issues in the week before and the first 2-3 days of menses. However, with continued lack of treatment, the time in the month during which you have pain tends to continually increase until there is pain all the time. Solution - treat the underlying condition - I’ll detail that in another blog. Avoid sex when it’s painful focusing on building intimacy and sexual pleasure without penetration.
Ovarian cysts - Each month as ovulation approaches, a follicle (or cyst you might say) forms on the ovary. It may be a little tender the day of and day after ovulation. Sometimes, that cyst doesn’t ovulate the way it should and grows to be 4-6 cm and that can be very tender, especially if it’s a hemorrhagic cyst. The good news is that this will resolve over the next few days. Just avoid sex for the duration and all should right itself. If you have developed a cyst over 6 cm, it’s best to have it removed because of the risk it will twist on it’s blood supply.
Trauma/abuse - In this age group, unfortunately this is probably the number one cause of painful sex. A good mental therapist and pelvic floor therapist and a trusting relationship are the keys to success, but it will likely take some time. Find a team of providers you trust and we can really help make it better.
Prolapse - it’s unlikely in this age group that your whole uterus will fall out, but what can happen is that you get laxity in the pelvic floor, especially after childbirth, weight gain and heavy lifting activities. If you have complete childbearing, repairs during the years you still have estrogen in your body heal beautifully and stand the test of time.
Hernias - it’s not uncommon to get some weakness around the round ligaments and you will often feel this as a tender spot inside the vagina or on the abdominal wall about 1/3 of the way from the front hip bone to the belly button. For some people it’s both sides and for others, it may be worse on left or right. You will likely notice exacerbation around the period and with being on your feet all day or with bearing down. Some will need repair, but that’s less likely. generally core strengthening, abdominal wall support will be enough to help manage symptoms. Some women will benefit from a hysterectomy, but it’s hard to know exactly who will get the most benefit.
The most important thing about painful sex is that you shouldn’t be afraid to discuss concerns with your doctor. It’s not embarassing to us and all doctors want their patient’s to improve, so speak up if you are having problems. Also, check out the post on orgasms - “Can I Ask You One Other Question.”