Healing Painful Sex: Deborah Coady, MD and Nancy Fish MSW, MPH

Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed or not diagnosed at all.  In Healing Painful Sex, Deborah Coady, MD and Nancy Fish use their combined professional expertise as a doctor and therapist who specialize in sexual pain to provide readers with an understanding of its many causes and how to treat them, from both a physical and psychological standpoint.

Organized into three parts naming the problem, getting a diagnosis, and overcoming pain Healing Painful Sex includes medical checklists, illustrations, vignettes based on interviews with women and their healthcare professionals, treatment options, and guidance for moving forward after healing.

Coady and Fish speak honestly and directly to sexual pain sufferers experiences, helping them address the problem of chronic pain, understand and prevent misdiagnoses, define medical terms and conditions, and regain sexual joy.

Comprehensive, multi-dimensional, and deeply insightful, Healing Painful Sex offers women the tools to successfully take on the many challenges of sexual pain and move toward a healthy, happy future.

Healing Painful Sex covers the following symptoms and conditions: Pelvic floor dysfunction, vulvodynia, pudendal nerve pain, clitorodynia, pelvic organ, endometriosis, painful bladder, irritable bowel, skin disorders, lichen sclerosis, hormonal, surgical, post-cancer and sexual pain.

Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives.

The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh), defined as persistent or recurrent genital pain that occurs just before, during or after intercourse.

Symptoms
If you have painful intercourse, you might feel:

• Pain only at sexual entry (penetration)
• Pain with every penetration, including putting in a tampon
• Deep pain during thrusting
• Burning pain or aching pain
• Throbbing pain, lasting hours after intercourse

If you have recurrent pain during sex and feeling pain during sex normal talk to your doctor. Treating the problem can help your sex life, your emotional intimacy and your self-image.

Causes

Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors might be associated with many types of painful intercourse.

Entry pain: Pain during penetration might be associated with a range of factors, including:

Sexual intercourse for the first time. The first few times you have intercourse or experience vaginal penetration, you may feel a small to moderate amount of pain at the entrance to the vagina. There can be some bleeding or no bleeding at all—both are normal.The reasons for the pain are not always clear, but it is typically temporary.

• Not enough lubrication.This is often the result of not enough foreplay.  In most women, the wall of the vagina responds to arousal by producing a liquid that moistens the vagina and its entrance, making penetration easier. Sometimes there isn’t enough lubrication — you may need more time for stimulation, or you may be nervous or tense. A drop in estrogen levels after menopause or childbirth or during breast-feeding also can be a cause. Certain medications are known to affect sexual desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.

• Injury, trauma or irritation.This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).

Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.  Some vaginal infection —like yeast or trichomoniasis—can be present even when you can’t see any signs. The friction of a penis, dildo, or finger moving on the vulva or in the vagina might cause the infection to flare up, resulting in stinging and itchiness. A herpes sore on the external genitals can make friction painful.

• These involuntary spasms of the muscles of the vaginal wall can make penetration painful.
• Congenital abnormality.A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could cause dyspareunia.

Deep pain: Deep pain usually occurs with deep penetration. It might be worse in certain positions.

Causes include:

• Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor dysfunction, adenomyosis, hemorrhoids and ovarian cysts.
• Surgeries or medical treatments.Scarring from pelvic surgery, including hysterectomy, can cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make you feeling pain during sex normal.

Emotional factors: Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain.

Emotional factors include:

• Psychological issues. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
• Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
• History of sexual abuse.Not everyone with dyspareunia has a history of sexual abuse, but if you have been abused, it can play a role.

It can be difficult to tell whether emotional factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sexual intercourse if you associate it with the pain.

Emotional causes of pain during intercourse: Stress, anxiety, and depression can lead to changes in a woman’s sexual response. In addition, if previous sexual experiences have been painful, the body may become tense in anticipation of another painful experience, which can ultimately cause pain during sex to occur again.

Feelings of fear, guilt, or shame can make it difficult for women to become aroused, which can make sex painful. For some women, emotional issues from previous sexual trauma or abuse can contribute to pain during sex.

Home treatment for pain during sex:

• Using lubricants
• Trying more foreplay before penetration is attempted
• Changing sexual positions (such as the woman on top) that allow the woman more control over penetration depth
• Trying sexual activities that do not cause pain

Because there are so many potential causes of pain during intercourse, it is important to consult a health care provider about the appropriate course of treatment for you.