SEX

Pleasure, connection, orgasm, love, energetic, relief, life, calming, spontaneous, vital, wonderful, consistent.

Pain, resentment, nervous, anxious, fearful, bored, jealous, angry, indifferent.

When you think about engaging in a sexual activity, what words come to mind?

If it's any from the blue list congratulations! Things appear to be going well for you. But if it more from the red list then you might need some help in this department from a professional.

*One study found that 21 percent of women aged 18-29, 15 percent aged 30-39, 13 percent aged 40-49 and 9 percent aged 50-59 experience painful intercourse. When they looked at what percentage of women stated sex was not pleasurable the numbers were as follow: 27% for 18-29, 24% for 30-39, 17% for 40-49 and 17% for 50-59.

These numbers are significant and tells you one thing (well more than one thing...) YOU ARE NOT ALONE. And THERE IS SOMETHING YOU CAN DO ABOUT IT!!!

So, what can you do? Glad you asked!

First, what is causing this pain? These are 7 of the main reasons a woman might be experiencing pain during sex.

FIRST and MOST common:

No or low desire/arousal. The vagina is not made to be penetrated without a warm up. The majority of pain during sex is because the woman is not aroused. During the arousal phase, blood travels to the labia, clitoris and vaginal walls, helping the area stretch and relax in order to penetrate. Without proper time stimulating the argenous zones, it can become painful. So.... take time to turn your partner on. Massage her, especially the buttocks and thighs, tease her. Give her oral pleasure with your tongue and involving your fingers or a toy. 85% of women can only have clitoral orgasms, leaving only 15% who can have them vaginally, so DO NOT ignore the clitoris. Make her the star of the show, but do not go there first. You need to warm up the entire body first before moving to the "magic button".

What else could be causing the pain?

Second:

Vaginal yeast infection or bladder infection. Go to your doctor to confirm these and seek the appropriate treatments. These can make sex very uncomfortable.

Third:

Vulvodynia: Pain in the vulva or the outside genitals (labia, clitoris and vaginal opening). The pain is often described as being a burning or stabbing pain and can happen during sex, during tampon insertion or during exercise. Treatment includes figuring out what the triggers are and avoiding them. Do not use soaps with detergents, no douching products, wear cotton underwear, avoid any product with a fragrance or scent around your vagina, use a natural or sensitive detergent, rinse vagina with cool water after sex and using the bathroom, loose clothing and LUBE. Biofeedback and physical therapy have also proven to be helpful with the treatment of vulvodynia.

Fourth:

Hormonal imbalance. This can happen during pregnancy, after the baby is born, while breast feeding and pre & post menopause. When your body is producing too much estrogen and not enough progesterone, this can lead to a lack of lubrication. Lubrication not only allows things to slide in and out more easily, but it also sends messages to your brain to tell you you are now turned on. Without it sex can become very painful, your vaginal wall may tear and even bleed. Make sure during the times in life when your hormones are not balanced that you supplement with a lubrication of your liking. There are water and silicone based. Remember to never use petroleum with condoms! I've also recommended coconut oil and your own spit. Some of these options aren't as hygienic, so only use the method that you feel most comfortable with.

Fifth:

Vaginismus: This is when the muscles of the vagina tense up making penetration extremely painful and sometimes impossible. For some women even tampons are painful to insert. The solution to this problem can be complicated but very possible to fix!

There are three main areas to focus on: the physical, the mental/emotional and the practical.

Physical: You need to go to a physical therapist that specializes in pelvic floor pain. This is very important! Don't just buy the dilators and experiment at home. You need to be shown which muscles to work with. Whether you need to learn to relax the muscles or strengthen them. There is so much that goes into the physical piece and assessment, you need to find a skilled and experienced physical therapist to help guide you through this. They will perform an internal exam on you to help, which can sound scary, so make sure they are aware if anything causes you pain during the exam.

Mental/Emotional: This is where a therapist, one specialized in sexual health, can help you explore where this pain is rooted in your past experiences, negative thought processes or trauma. Not all pain is caused from a sexual trauma. Sometimes it was an over controlling family member or a personal struggle with one's upbringing around sex. With a skilled therapist, you will begin to unravel how your early years may have lead to or fueled this painful reaction.

Practical: This is everything else in your life. Your social life, your hobbies, your relationships, family, work and life's ambitions. It is important to have a well rounded life where you have enough time to focus on what makes you happy while keeping up with your everyday obligations. What do you do to relax? Take time for yourself? What do you like to do for fun? If you answered either "nothing" or "I don't know", then you can also work towards fulfillment in this area with your therapist.

Sixth:

Endometriosis: This is where the lining of the uterus grows in other areas. This can cause sex to be painful. Go to your doctor and have them screen you for this if you have painful sex and painful periods. You might have to have surgery to help fix this issue. In the meantime..... Lube.

Seven:

Wrong position. Sometimes the penis might be too long for the vagina or a certain position has it hitting the wrong spot. Some women like the feeling of the penis hitting their cervix and some don't. Change positions if it's uncomfortable. Try a pillow under your back or under your stomach. If you're doing "doggy style" try it flat instead of downward dog angled. Try the female on top so that she can control the angle. And of coarse, again, LUBE!!!

Still need more? Give me a call today and we can set up a time for an initial assessment. You don't have to have painful sex forever. It can get better.

*Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. JAMA. 1999;281(6):537-544. doi:10.1001/jama.281.6.537.