All this month Dr. Kate, an OB/GYN at one of the largest teaching hospitals in New York City, is dedicating her column on EMandLO.com to the topic female sexual dysfunction, since that’s what she seems to get the most inquiries about. Click here for all the installments of her five part series being published every Thursday afternoon in January.
Sex should never be dreaded, and should never cause you pain. Unfortunately, for some women, pain during sex takes all the pleasure out of what should be a wonderful, intimate experience. And pain is never normal. It’s your body’s way of telling you to stop what you’re doing. The official term for pain during intercourse is dyspareunia, and there are multiple reasons why it might be happening. Fortunately, there are answers for most of them.
- Tightening in anticipation. The vagina is a powerful muscle. If you’re not fully relaxed before intercourse, you can feel a lot of pain with penetration. And if you’ve experienced pain before, it’s natural to “tighten up” when a penis is approaching you. So you’ve got to make sure you’re relaxed and warmed up. It takes the average woman 20 to 30 minutes of good, sexual attention to become both aroused and lubricated enough for intercourse. And I don’t mean him feeling up your boobs — that’s foreplay for him (unless that happens to work for you as well!) Make sure that you get lots of playtime first: his fingers, or going down on you, or a vibrator, whatever works for you! Having an orgasm prior to intercourse can help with engorgement of the area and natural lubrication, two things that make intercourse much more pleasant for a woman. And make sure he enters you very slowly, to give your vagina a chance to adjust. Better yet, get on top so you can control the pace of penetration.
- Not enough lubrication. Simply not being lubricated enough is the number-one reason for pain during sex. Both wetness and engorgement signal your readiness for sex, so starting before they take place can hurt. There are many reasons for dryness, most of which have nothing to do with how much you want sex. If you’ve been taking an anti-allergy medication, for instance, that could be the culprit; antihistamines are one of several medications that can lead to dryness (others include antidepressants and the Pill). If this lack of lubrication is a continual problem, talk to your doctor about it. But for immediate help, use a man-made, water-based lubricant. Apply it to his penis and your labia liberally before insertion. And again, make sure you’re getting enough good stimulation beforehand.
- A retroverted uterus. About 20 percent of women have a retroverted uterus (where it tips back toward the tailbone, instead of forward toward the bladder), which makes your cervix vulnerable to getting bumped during intercourse. But the mishap can happen to any woman during sex, especially if her partner is overenthusiastic in the jackhammering department. So insist on positions and a depth of penetration this is comfortable to you.
- Chronic pain conditions. There are three main ones:
- Endometriosis, where tissue that looks and acts like the lining of the uterus grows outside of it — on the ovaries, fallopian tubes or even the abdominal wall. Aside from uncomfortable sex, it can also cause constant pelvic pain and excruciating periods. The Pill, or other hormonal birth control, is the best treatment.
- Interstitial Cystitis (IC), an inflammation of the bladder that causes a stinging sensation when you pee, and a frequent, urgent need to go. It’s often misdiagnosed as chronic UTI because of the similar symptoms. If you’re visiting the restroom hourly and are hurting during or after sex, see your doctor for an evaluation and ask about IC.
- Vulvodynia, a fancy-pants way of saying “pain in the vulva.” Other signs that you may have vulvodynia: does it hurt if he puts a finger inside you? if you use a tampon? if you wear tight jeans or pants? Often, women with vulvodynia have pain on ANY contact to their vulva, not just intercourse. If you think this describes you, there are treatments available — most often a combination of oral medication and a topical anesthetic cream — so talk to your gyno.
Whatever is happening, once you can figure out why you’re hurting, you can figure out ways to make sex more enjoyable — something that makes you shiver in anticipation, not dread.
— Dr. Kate
Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.