Painful sex (or Dyspareunia) is distressing. As well as the physical pain, there is the emotional pain women feel when they are unable to enjoy sex with their partner. No one feels like sex if it hurts, but it is easy for him to feel you don’t care.
There are lots of possible causes but with some help, you and your doctor can usually work out what the problem is. To make it easier, it’s a good idea to think about where your pains are before you go, and see if you can help your doctor find the problem. If you find a sore area, think about whether this feels like the pain you have with sex, or whether it is a different pain. A common cause of painful sex is painful pelvic muscles.
Painful pelvic muscles
The pelvic floor muscles are the ones you tighten when you want to stop passing urine quickly. They can become tight, strong and painful. Often there is an ache in the pelvis much of the time, sometimes with sudden crampy spasms. Intercourse, examinations, or using tampons are very painful and sometimes the pain lasts for hours or days afterwards. There may be sudden sharp or stabbing pains up the vagina or bowel when the muscles cramp. Pain is often worse with exercise and isn’t helped by normal pain medications.
You can check your pelvic muscles yourself by inserting one finger just inside the vagina. Push backwards towards the bowel with your finger, then push sideways towards your hip on each side. Does pushing these muscles cause the same pain you get with intercourse?
If pushing the front wall of the vagina causes pain and you have bladder troubles, then the pain may be due to painful bladder syndrome. Treating the bladder problems often helps.
The pain is deep and worse at period time
Endometriosis can cause painful intercourse deep inside, especially if it lies between the uterus and the bowel. However, this is difficult surgery, and you will need a gynecologist skilled in difficult laparoscopic surgery. A laparoscopy will not fix pain from pelvic muscles.
Sore vulval skin
The vulva is the area between your legs and the labia are the folds of skin near the opening of the vagina. If the skin is sore, good ideas include:
Use sorbolene and glycerine cream instead of soap when you wash.
Avoid waxing the hair on the labia
Ask your doctor to check for a vaginal or thrush infection. If you have a lot of trouble with thrush, then a weekly tablet of fluconazole
150mg for 6 weeks or longer if needed often helps
Try a low dose of amitriptyline
Use a 2% amitriptyline cream if you are tender just at the opening of the vagina
See a ‘vulval dermatologist’ (skin doctor) if you still have problems
What can I do? Useful treatments
Use a heat pack or a hot bath when the pain is severe
Do the easy stretches for women (twice daily) at www.pelvicpain.org.au
Download the pelvic muscle relaxation mp3 tape (it comes with instructions) at www.thepelvicfloorclinic.com.au
See a specialized women’s physiotherapist to help the muscles re-learn how to relax and move normally.
Continue regular gentle exercise, such as walking, but avoid exercises that hurt you. Core exercises such as Pilates may aggravate the pain. Avoid prolonged sitting.
Explain to your partner that you should avoid vaginal intercourse until the muscles improve. Sexual activity without penetration is fine, It is best to avoid intercourse until your muscles have recovered.
Use a vaginal trainer (dilator) to slowly teach the muscles to relax. This is best taught by a woman’s physiotherapist.
Use a small dose (5-25mg) of amitriptyline early each evening, or duloxetine (30-60mg) in the morning. Your doctor can arrange this, with instructions on how to use these available at www.pelvicpain.org.au
Treat other causes of pain so there is less need to hold muscles tightly
Think about how you hold yourself and avoid holding tensing in your pelvis
If the muscles are so painful that physio is difficult, then a botox injection to the pelvic floor is often helpful. The botox is injected as day surgery under anesthetic, lasts 4-6 months and stops the muscles cramping. It also makes physiotherapy easier.
Content provided by Dr Susan Evans, Gynecologist, Laparoscopic Surgeon, & Specialist Pain Medicine Physician (https://www.drsusanevans.com.au/). Permission has been granted to publish this content on www.theendolifestyle.com.