You are not alone. Many women do everything they can to avoid sex for one reason: it hurts them. The medical term is: dyspareunia. You may have heard the term “vestibulodynia” or “vulvodynia.” This refers to pain at the entrance of the vagina, or pain with sexual insertion. It affects women of all ages, of all shapes and sizes, of all ethnic, socioeconomic and religious backgrounds.
If you suffer from discomfort during sex, there’s no amount of love, no amount of desire, that will make it pleasurable for you. It hurts. The analogy is the lesson we all learn as kids about a hot stove. Once you’ve burned your hand on a burner, you instinctively pull back from it. Sexual pain is like the hot stove.
The key to treatment is to figure out the cause of the sexual pain.
Physical causes: The physical causes of sexual pain disorders are very real. And regardless of the culprit, the burning, throbbing or pain you experience during sex means you’re not enjoying something you should be enjoying.
Tight pelvic floor muscles. Side effects from hormonal contraceptives. Persistent yeast infections. Vaginal thinning and dryness with menopause. Sexually transmitted infections. Hormone imbalance. Thyroid disorders. Vulvar skin disorders. Urinary problems. All of these physical issues can be addressed via the Center for Sexual Health.
Depression, anxiety, stress and certainly prior history of abuse can affect intimacy. We can help you and your partner understand your diagnosis and provide you with counseling you may need to break the sexual dysfunction cycle.
Anti-depressant medications. Birth control pills. Alcohol. Smoking. Recreational drug use. Lack of exercise. Diet. We will evaluate any risk factors that may be holding you back.
Diagnosing the problem:
We’ll take a full medical history. We need to ask you some personal questions and we need to take a good look at you. We’re going to take some blood and some urine, too, to help us determine whether the issue is primarily congenital, hormonal (endocrine), musculoskeletal or neurologic in origin.
In young women, it may be as simple as changing your birth control choice - which could, ironically, very well be causing your desire, lubrication, and even pain problems. Post-menopausal patients and younger women on long-term birth control pills may benefit from topical medication applied to the entrance of the vagina. We may be able to treat with creams, pills, or even a flexible ring which slowly releases estrogen directly to the vagina.
Women with tight pelvic floor muscles may benefit from pelvic floor physical therapy to restore blood flow to the area and decrease burning pain at the entrance of the vagina.
Dryness, burning and irritation may also be a side effect of radiation or chemotherapy treatments, an undiagnosed infection, or a skin disease of the vulva. Once we understand the cause, we can begin to treat you. That’s another reason for our very thorough initial appointment.
Lastly, if you’ve been avoiding sex because of pain, you might need to speak with a counselor no matter how much you love your partner and want to have sexual relations. The years of pain associated with intercourse may elicit an involuntary physical reaction that causes you to pull away - emotionally and physically. We can help both you and your partner restore the intimacy you both want.
The Center for Sexual Health at George Washington Medical Faculty Associates
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