Painful sex can have a huge impact on your mental and physical health, causing a reduced libido, lower mood, reduced self-confidence and affect relationships and impact conception. We talk to Dr Leila Frodsham, Consultant Gynaecologist, Psychosexual Medicine and Menopause Specialist and spokesperson for Royal College of Obstetricians & Gynaecologists to find out just how impactful it is and the support available to help you overcome this intimacy barrier.   

What are the common causes of painful sex?

Pain during sex is common (7.5 % of all women experience this but increases at the start of sexual activity, after child birth and in menopause to 13-50%. Nearly 1/5 of Gynae referrals are for sexual pain) and can caused by physical and/or emotional problems. Any pain during sex can affect desire/libido.

Pain felt in the vagina may be due to the menopause (a change in hormone levels that can cause vaginal dryness), some progesterone only pills, childbirth, breast feeding, a lack of sexual arousal, vaginismus (involuntary contraction of the muscles), candida (thrush) or genital skin conditions. Sometimes no physical cause is found and this might be called Provoked Vulvodynia and this often causes vaginismus as the body’s response to pain is to contract muscles. Pain felt inside the pelvis may be the result of a condition such as endometriosis, adenomyosis, pelvic infection, irritable bowel syndrome, or constipation. Fibroids rarely cause pain during sex.

Any cause of pain can lead to low desire and vaginismus even if the original cause is treated and sometimes an emotional reason or anxiety could be causing the pain. If this is the case a counsellor or sex therapist may be able to help – your GP or sexual health clinic can refer you to one and health care professionals who manage both physical and emotional causes can be found on the Institute of Psychosexual Medicine website. Pelvic floor physiotherapy can really help with managing vaginismus.

If you get pain during or after sex, please do speak to a healthcare professional who will be able to signpost you to help if they cannot offer help themselves.

What is the impact of painful sex on reproduction?

Painful sex may impact fertility because if you are experiencing pain when having sex, you may not have sex as often which makes conception less likely.

Furthermore, numerous causes of painful sex such as endometriosis, adenomyosis, fibroids or infection could have a more direct impact on your fertility.

If you are worried about your fertility or if you have been trying to conceive for over a year, you should speak to a healthcare professional who can investigate. Sexual Health clinics can be helpful in finding a specialist.

How can this intimacy barrier be overcome?

Reducing allergens by changing washing routines (no soaps or shower gels, even if they are described as gentle/pH neutral, should be used on the vulva or vagina as they self-clean), changing to low allergen washing powders and moving from gel pads to period pants can help with pain.

Massaging the pelvic floor and opening of the vagina with a vibrating massager or thumbs with a low allergen oil-based lubricant or coconut oil can reduce discomfort and enable relaxation of the pelvic floor but also improve the skin health. Pilates and yoga pelvic stretches can really help with regaining control of the pelvic floor to enable relaxation.

Scheduling time for sex with no interruptions and focusing on building confidence with massage can really help.

Are there positions that can make sex more comfortable and enjoyable?

Couples often find that moving from deep penetration positions to side-by-side sex can help, with plenty of lubrication. There is also some benefit from using desensitising lubricants around the opening of the vagina. These can also be used for pelvic floor massage.

There is evidence to support pelvic floor massage regularly and before sex. Making sure that arousal is good also really helps.

When should you see a medical professional regarding painful sex?

It is important that women who experience recurrent pain during or after sex, speak to a healthcare professional so they can explore the cause behind this. Any woman with sexual pain that lasts more than a few occasions should seek help. Many women suffer for many years before seeking help and it is rarely discussed despite being very common. No one should find sex painful and there is lots of help around.

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