I am 58yr and have had painful sex for the past 10years and I am too embarrassed to discuss it with my husband and my doctor. Please help me!

 

Persistent painful sex is medically known as dyspareunia. There are many known causes of painful sex. It’s important to know that it’s not normal to experience persistent painful sex. Paying attention to your body during sex will help you understand the potential cause. Discussing the details of your pain during sex will also help a healthcare provider guide you through a diagnosis and treatment plan.

The healthcare provider knows the long list of potential causes of painful sex. Getting a detailed history and performing a gynecologic examination will help make the diagnosis clearer to a trained physician. Other health care providers including a sex therapist and a pelvic health specialist/physical therapist is often necessary to help treat the underlying condition.

 

Vaginal dryness is a common cause of painful sex.  Here’s what you need to know. 

The natural lubrication of the vagina can dry up with prolonged sexual contact and penetration causing friction and pain. If you haven’t had the right amount of foreplay to become sexually aroused and “get wet”, the vagina will be dry having sex painful when the penis or fingers enter the vagina. Water or silicone-based lubricants and extra virgin coconut oil are great additions to long periods of intimacy.  Dryness can also occur in menopausal women who are not taking any oral or vaginal estrogen which results in a burning sensation inside the vagina, especially with sex contact and penetration.

Using an internal vaginal moisturizer on a regular basis can also help maintain the environment of the vagina and help prevent on-going vaginal dryness with sex.

 

How can endometriosis cause pain during sex? 

Some women with endometriosis may experience pain with sex depending on where the endometrial implants are located in the pelvis. If the implants are on nerves, ligaments and tissue stretched during sex, pain can be significant and, often, unbearable lasting hours and days afterwards, making sex impossible.  The pain during sex can be so horrible that many women will not be able to have sexual penetration.  This can have permanent mental and physical consequences on a sexual relationship.

 Certain sexual positions are known to be anatomically harder on the vagina and female organs including the uterus and ovaries.  The “Missionary” position tends to be easier for women and their anatomy whereas “Doggie Style” or from behind, allows for deeper penetration for the male but more discomfort and pain for many women. It’s completely normal for women to experience pain or cramping during sex depending on certain sexual positions.  Learn and know what positions are less uncomfortable and painful during sexual intercourse with your partner.

 

Can skin disorders come into play when it comes to painful sex? 

One of the most disruptive and chronic conditions involving the vulva is called Lichen (pronounced: like-in) Sclerosis, which represents nearly forty percent of skin disorders. With LS, the skin of the vulva becomes ivory or white, like the color of cigarette paper or parchment, and is accompanied by intense itching, burning and pain. Sex can be a source of discomfort and pain.

Hidradenitis Suppurativa (HS)-Not so affectionately known as HS is a condition where the hair follicles of the vagina become blocked, swollen and tender. Having sex during about of HS can be extremely painful, if not impossible.

 

How does Lichen Sclerosis cause painful sex?

Lichen Sclerosis (LS) is the chronic and painful skin condition of the vulva called Lichen (pronounced: like-in) Sclerosis, which represents nearly forty percent of skin disorders.

With LS, the skin of the vulva becomes ivory or white, like the color of cigarette paper or parchment, and is accompanied by intense itching, burning and pain. Intercourse and urination may also be a source of discomfort and pain, although a small percentage of patients do not have any symptoms at all. Most commonly seen in women 40-50 years of age, LS can affect any age group. No one is certain as to what causes Lichen Sclerosis, but we do know that it is not contagious. Diagnosis is made by examination and a biopsy of a small patch of the affected area. 

Treatment of Lichen Sclerosis is found in steroid creams to control the symptoms. Meanwhile, there are ways of taking care of your skin while the creams take effect. These include:

• Removing potential skin irritants from use, such as detergents and fragrant soaps 
• Taking sitz baths with baking soda or Aveeno baths 
• Using olive oil, extra virgin coconut oil or shortening as moisturizers
• Using skin protectants such as A & D ointment or KY jelly
• Avoiding tight-fitting clothing such as pantyhose and jeans (cotton underwear is recommended)

 

Why does Hidradenitis Suppurativa (HS) cause painful sex?

Not so affectionately known, HS is a condition where the hair follicles of the vulva and vaginal area become blocked, swollen, inflamed and tender. Painful lumps under the skin burst and tunnels can form under the skin. HS can be found anywhere on the body with hair follicles including the armpits, groin, buttocks and breasts. 

The cause of HS is not fully understood but genetic and environmental factor are a contributing factor.  Symptoms are more common after puberty but before 30y, women are more likely to get HS than men, a family member may have had it, obesity and tobacco use are other factors associated with HS. Medication and surgery is often the best way to treat HS.

HS has nothing to do with poor hygiene and it is not contagious.  It’s a chronic, embarrassing and painful skin condition of the vulva and vagina. Finding a dermatologist who knows how to treat and manage HS is so important. 

 

How does vulvodynia and vaginismus cause painful sex?

Vulvodynia is an extremely painful condition involving the vulva and vagina, the causes of which are unidentifiable. Symptoms include burning, stinging, itching, throbbing, swelling and soreness—an agonizing, disruptive recipe in the bedroom. Sex can be painful as a result of these skin changes.

Vaginismus is an unusual condition which causes the muscles of the vaginal opening to tighten, making sexual intercourse and pelvic examination painful to the point of impossible.

 

Can vaginal infections cause painful sex?

The signs and symptoms of a vaginal infection may include vaginal discharge, odor, or itching, which may be the cause of your vaginal pain and swelling with sex. 

Sexually transmitted infections (STIs) such as Chlamydia and Gonorrhea are the typical culprits of PID, a serious pelvic infection that can lead to infertility and pelvic pain. Getting STI checkups is especially important when you change sexual partners.

Can vaginal tears cause painful sex?

Tears and lacerations can result from many things—sex without proper lubricant, a larger than average penis, use of a particular sex toy or trauma from childbirth. Vaginal lubricants and lidocaine gel can help avoid some of these problems and, make sex, more enjoyable.

Can condoms cause painful sex?

The majority of condoms are made out of latex, which propose little problem to most women, except those with latex allergies. An allergic reaction to latex may involve vaginal swelling, itching and pain during and up to 36 hours after sex. If you have a latex allergy, you can use a polyurethane condom as an alternative for your safe sex measures.

Can ovarian cysts can cause painful sex? 

Ruptured Ovarian Cyst can cause pain with sex. If you are having sex during ovulation or mid-cycle, chances are there is an expected large ovarian cyst waiting to ovulate and release the egg. Aggressive sex can cause this cyst to rupture, releasing its fluid contents along with the egg and causing pain. A pelvic ultrasound combined with your menstrual history can help with a proper diagnosis.

 

Can intestinal problems cause painful sex?

Irritable bowel syndrome is more common than you think.  It’s defined as “recurrent abdominal pain or discomfort that occurs in association with altered bowel habits over a period of at least 3 months”.  The 3 ways the “altered bowel habits” can present is with constipation, diarrhea or the double whammy, both constipation and diarrhea. Having a sensitive intestinal tract can make the act of sex excruciating if you are having a painful attack of IBS.

 

Can depression cause painful sex?

For those suffering from constant and on-going stress, long term physical and mental medical complications can occur.  Depression, anxiety, insomnia, weight loss or weight gain, poor concentration, accidents, high blood pressure and heartbeat irregularities are some of the common medical conditions associated with chronic stress. All this can lead to a low sex drive and the potential for painful sex.

Depression, anxiety, relationship problems and fear of intimacy all play a role in painful sex. Psychotherapy and the ability to communicate your feelings to your partner can help overcome some of the emotional problems that may inhibit a healthy, enjoyable sex life.

 

Can a history of sexual abuse cause painful sex?

 

Any history of sexual abuse and trauma (emotional or physical) can contribute to an aversion or general dislike of sex. A devastating experience that leads to “post-traumatic stress disorder” may only enable you to feel pain with sex. As in dealing with emotional problems, therapy and an open communication with your partner is key to helping resolve issues linked to abuse and trauma.

 

Is “bigger better” when it comes to penis size and sexual intercourse?

I am convinced it was a man who started the rumor, “bigger is better” for women when in fact it’s really not the case from a Gyno perspective. One study showed that 77% of females said penis length was “unimportant or totally unimportant, compared with 21% who declared it was important or very important”. Another study showed that penis width was “more important to sexual satisfaction than penis length”.

The typical penis is an average of 5.6 inches (14.2cm) long and 4.8inches (12.2 cm) in diameter (girth). A vagina will stretch and acclimate to the size of a particularly large penis, but it may take time and patience. If your guy has an extra thick or long penis the first step is to have an open and honest conversation about how your vagina is handling a larger penis. Chances are he already knows other women have commented on his plus size penis.  Use adequate lubrication, avoid positions of deep penetration and take it slow.  Some women may have to use topical lidocaine at the entrance of the vagina before sex and others need to use vaginal dilators or a dildo to increase the size of the vaginal opening. For those with a longer penis there are “penis rings” used at the base of the penis to prevent deep penetration. Soaking your vagina in a warm water bath with extra virgin coconut oil will soothe and hydrate the vaginal opening and labia minora and majora.

Certain sexual position are known to be anatomical hard on the vagina and female organs.  The Missionary position tends to be easier for women and their anatomy. Whereas “Doggie Style” or from behind allows for more deeper penetration for the male but this position can cause pain for many women. 

 

How is painful sex treated?

Communication with your partner is important to avoid painful sex. It is not normal to feel or expect pain with sex. Understanding why you are experiencing pain with sex is the first step in preventing it from happening. You need to be honest with your partner to understand the cause. Don’t let things between the sheets get carried away. Pleasure in the bedroom has to be important not only for your partner but also for yourself.

Bad lifestyle habits or untreated medical conditions that can slow your sexual response or ability to have an orgasm can create anxiety and frustration. Knowing women’s sexual desire starts above the shoulders, many of these conditions cause a lack of intimacy and sexual dysfunction. If your brain is not feeling desire or excitement, sexual dysfunction follows. 

Other medical conditions or poor lifestyle habits affect the bloods’ ability to flow through the blood vessels.

Alcohol and drug use can affect sexual response and performance since they often have a sedating effect.

Smoking tobacco restricts the blood flow all over the body including the clitoris and vagina.  Long time tobacco use limits blood flow to the sexual organs affecting the ability to be aroused and have an orgasm.

Getting a good night’s sleep is critical to good health, mentally and physically.  The recommended hours an adult should sleep is 7 to 8 per night.  If there are several nights where you are losing 1 to 2 hours per night this can cause signs of sleep deprivation.  The hour’s loss during each night accumulates and is impossible to get back. Sleep deprivation can affect your ability to be efficient at work, school, home and in the bedroom.  Sleep deprivation causes a poor sexual interest and can lead to painful sex.

 Over-eating unhealthy foods lead to obesity and other chronic medical conditions.  Obesity can affect women’s emotional interest and physical ability to be sexually intimate in all ways.

Seeing a sex therapist should also be part of your treatment plan.

 

What can breast cancer survivors do if they suffer from vaginal dryness?

Treatment considerations include receptor status, genetic characteristics, extent of disease, time interval since diagnosis and response to prior therapies. 

• Education, Communication, Counseling & Sex Therapy
• Treatment should begin BEFORE treatment for breast cancer is initiated
• Moisturizing-Nonhormonal First Line Treatment

-Vulva-Products made for the vulva or coconut oil directly to vulva

-Vagina-Maintains tissue integrity, elasticity, and pliability. Hyaluronic Acid, Key-E Coconut oil/Vit E, Replens, Me Again, Prohydrate, Feminease every 1 to 3 nights

Lubricants-Reduce friction & discomfort during penetrative sexual activity-water, silicone or oil-based

• *Hormonal-For Severe GSM-Low dose vaginal estrogen, DHEA (Prasterone) or Testosterone every 2 to 3 nights
• Lidocaine-Used topically for pain at the entrance of vagina
• Morpheus8-Comines radiofrequency and micro-needling to rejuvenate the vagina and vulva. FDA cleared, increase production of collagen and elastin
• Mona Lisa Laser-Micro-ablation fractional CO2-blood flow/collagen production
• Vaginal Dilators-reduce pain with penetration by improving vaginal elasticity
• Vibrators-increases blood flow, improves desire, arousal & orgasm
• Pelvic Floor Physical Therapy-reduces pain with penetration, strengthening, & control

 

Discuss these treatment options with your breast cancer team of doctors to ensure they are supportive of these possibilities. Women have a right to their sexual health. Be your best health care advocate, your quality of life and sexual wellness depends on it!

 

Can women with breast cancer take vaginal estrogen to treat pain with penetration and vaginal dryness?

With more than 2 million US survivors of breast cancer affected by Genitourinary Syndrome of Menopause (GSM) causing vulva and vaginal dryness, burning, irritation, itching, painful sex (dyspareunia), urinary symptoms of urgency, frequency, dysuria and recurrent UTI’s, clitoral shrinkage, introital stenosis (vaginal entrance shrinkage), friable, hypopigmented with petechiae, ulcerations, tears, urethral polyps, prolapse and caruncles and bleeding, what can be taken safely to get their lives back on track. GSM is a progressive and common medical problem that completely shuts down sexual functioning and quality of life.

First line treatments, consistent with the guidance from the North American Menopause Society (NAMS), is using lubricants, moisturizers and pelvic floor physical therapy.

Vaginal estrogen has not been recommended in the past to breast cancer survivors to help reduce symptoms caused by GSM.  There is now some good news for breast cancer survivors paralyzed by the effects of GSM on themselves and their partners. A recent observational study found “no association between single-agent vaginal estrogen therapy or menopausal hormone therapy and increased risk of recurrence or mortality in patients with breast cancer”. Studies show vaginal estrogen is generally safe for breast cancer survivors. Discussing this option with your oncologist and gynecologist is the best way to know if you are a candidate.

 

Can breast cancer patients take medications for a low sex drive?

Testosterone is a medication that can be given to breast cancer patients for low sex drive. Testosterone comes in many different forms, from creams, ointments and gels that go on the legs, arms or stomach area. The dose given would be discussed with your health care team. Side effects of testosterone therapy include acne, hair growth the face and body, hair loss on the head, and weight gain. 

Addyi (flibanserin) works at the core of where a low sex drive begins and that is in the brain. Even though the exact mechanism is not completely known studies show there are areas in the brain that control women’s sexual response for those suffering from a low sex drive.

 

Addyi is thought to work on neurotransmitters in the brain including serotonin, dopamine and norepinephrine, which are all thought to be involved with sexual desire. The “pink” pill for women encourages the chemicals in the brain to get excited about sex and inhibits those that have a negative effect on the desire to have sex.

As always, discuss these options to treat a low sex drive with your health care team to ensure you are a suitable candidate.

 

What are the most common sexual problems for older women?

The 2 most common symptoms are painful sex and lack of desire affecting women older than 50years. Other concerns are lack of arousal and inability to reach orgasm. It’s estimated that close to 45% of women have some sort of sexual concern but many are not addressing it with their healthcare provider. 

According to Dr Sheryl Kingsberg, PhD from Universaity of Hospitals in Cleveland, “Many women believe that sexual dysfunction is a natural part of aging,” she says. “Part of that is true, but that doesn’t mean we can’t do something about it. Women color their hair to look younger and go to the gym to feel better. But when it comes to sexual concerns, most simply live with them without asking whether help is available.”

While men quickly discuss their sexual problems with their health care professional, women are just not doing the same.  Kingsberg goes on, ” “While sexual dysfunction is openly discussed in men, it’s become a taboo topic among women that is not often addressed by a health care professional. However, bringing these issues to light is the best way to make sure you’re enjoying sex throughout the entirety of your life—as you should!

I agree with Dr Kingsberg that women must empower themselves to find a trusted and competent healthcare profession to help them enjoy sex as they age and “reclaim your sexual power and identity”.  

 

Porn, who’s watching it?  

Who isn’t interested in watching porn? Let’s be real, it’s a completely normal curiosity! It’s literally a push of a computer button away to access a web site to see straight and homosexual sex acts of many garden varieties.  Some you can imagine and some you cannot! It’s normal to be a voyeur, a fly on the wall while women and men, women and women and men and men have sex.  A healthy dose of porn is fine, really…but when is it a concern?

 

What impact is the porn industry having on women and men when it comes to vaginas?

The truth is a lot of women don’t like their vaginas. 1 in 7 women have considered getting ”labial-plasty” which basically is trimming and tucking the lips of the vagina and tightening up the entrance.  Many women admit that 1 in 5 compare themselves to those vaginas seen in porn. With porn on the rise, vaginas are everywhere. And yet, no one seems to want to admit how this new prevalence, and its resulting misconceptions about sex and the vagina is—or isn’t—changing our romantic and sexual relationships and our relationships to our bodies and ourselves.

Dr. Gail Dines is a professor of sociology, modern day hero and a leading anti-porn feminist to tie the “porn monster down that has taught our girls to hypersexualized and pornify themselves.” Dr. Dines is on a mission of education, within which she and her group Cultured Reframed plan to use a public health approach similar to how my generation was educated about drinking alcohol and driving. She won’t be the only one wanting to reclaim our young girls and boys!

There’s no denying it. Porn is everywhere. Dr. Dines puts a perspective on this issue of accessibility of porn when she tells us, “Porn sites get more visitors each month then Netflix, Amazon, and Twitter combined.” A recent statistic found that 70% of children ages 8 to 18 report having unintentionally stumbled across pornography online. The average age for a child to be exposed to pornography is now 11 years old. This means that our children are often “learning” about “normal” sexual behavior and physical appearance from the likes of Jenna Jameson and John Holmes. Many women (and men) now expect, even want, all vaginas to look like Jenna’s does. Girls and guys alike visit porn and other sexually graphic web sites, and not just to get off, but also to see what the perfect vagina and the ideal penis look like.

 

What can we do to fight against the negative impact porn has on women? 61

My biggest concern is the ever-growing big business of porn.  It has become a public health issue similar to alcohol and drug addiction.  Porn has been the cause of failed marriages, losing a job and taking people down a dark path of self-destruction. The studies are clear, porn addicts will suffer damaging effects, both short and long term.

Young women have easy access to health information through social media, the internet, chat rooms, gossip magazines and, yes, porn.  So much of what women find through these channels is full of misleading, inaccurate, and mentally confusing information.  

This is where I come in—with my agenda of vagina empowerment! I want to reduce your anxiety and help young women have more realistic expectations about what’s normal by giving them an accurate view of the vagina in general. Believe me, the perfect vagina is actually a medical norm and not an aesthetic ideal. The only qualities that make a vagina “perfect” are good health and personal confidence.   

We, as a society, need to find ways to manage this ever-growing problem for the sexual health of women and men of all ages, ethnicities, cultures and demographics. Everyone must become involved and take responsibility to do their part to stop children and young women from becoming exposed to porn at the wrong time in their lives when they are not ready to properly process what they are seeing.  The time is now to stop the porn monster from negatively influencing our views on what is normal in the bedroom. Porn can be a part of your sexual life as long as it doesn’t consume it!