Don’t Suffer in Silence: Talk to Your Provider about Painful Intercourse

Women don’t talk about it, but they should. Painful intercourse, or dyspareunia, is more common than you might think. It’s often caused by a medical issue which shouldn’t be ignored. But we can’t treat it if we don’t know about it.

Don't Be Shy About Talking with Your Provider

You don’t have to be shy about bringing up this health issue with your care provider. I often start the conversation during a routine well woman visit by asking broad questions, and your provider may do the same.

Causes of Pain During Intercourse

Pain is a symptom you shouldn’t ignore and that’s the case when it comes to intercourse. There are many possible causes, including:

• Lack of lubrication
• History of recent pregnancy or childbirth
• Endometriosis
• Dryness, loss of elasticity, loss of lubricating secretions due to menopause or perimenopause
• Relaxation of the pelvic organs
• History of sexual trauma
• Other vaginal or vulvar conditions

Help for Women During Menopause

Treating an underlying medical issue, such as endometriosis, is essential to your overall health. But the solution can also be as simple as using a water-based lubricant, which I encourage women to do each and every time.

If you are approaching or have gone through menopause, decreased estrogen levels can thin the vagina lining. Water-based lubrication can help, but you may also need vaginal estrogen to build the lining of the vagina back to its premenopausal state. These vaginal estrogens are very low-dosed and mainly act locally to help resolve vaginal dryness and lack of elasticity.  Other non-estrogen options are available as well.

Physical Therapy for Pelvic Floor Issues

Just don’t suffer in silence. This can exacerbate the problem because you naturally start tensing vaginal and pelvic floor muscles, which leads to more pain even after the original cause has resolved. This creates a vicious cycle because pain naturally decreases your desire for intimacy, which may lead to challenges in your relationship.

A new tool that has helped many couples through this issue is referral to a physical therapist specially trained in pelvic floor physical therapy. These specially trained physical therapists can help identify tense muscles or other causes of pain and work with you to relax those muscles. They can also teach you exercises which will help keep the pain away.

It all starts with a conversation. I often tell women how important it is to have open and honest communication with their partner. This alone can help with relaxation and willingness to work through the issue. Just remember that problems with sexual intimacy are very common. I want to empower all of you to speak up and tell your health care provider if you are having any issues. You can soon be on your way to improvement. Reach out to a CHI Health OBGYN for more questions.