Pain with Sex

If you have pain with sex this is not normal.
Just want to make that point VERY clear!

In this episode I talk about 5 of the most common causes of pain with sex. As well as how they are diagnosed and treated so that you can have these important discussions with your doctor if this is something you are experiencing.

Sex should be fun for us too!
So take a listen and hopefully this helps ~Xo Dr. C

Transcript

SPEAKER_00: 0:00

Hi everyone, welcome to another episode of the Four Vaginas Only podcast. In this episode, we are going to talk about painful sex. But first, let's cue the music. Hello, and welcome to Four Vaginas Only, the podcast about everything female. I'm your host, Dr. Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. All right. Welcome, welcome to another episode of FVO or Four Vaginas Only, the podcast. I am Dr. Celestine, your host, and in this episode, we're going to talk about pain with sex. So I'm going to break down a few, you know, to be more specific, five causes. There are a lot of different causes. So this is not every single cause, just some of the most common that I've seen in my practice. But first, I just want to say pain with sex is actually pretty common. So I don't want women out there to think that if they're having pain with intercourse, whether it's something new or something that's always been going on, that that's just something they're supposed to grin and bear. Like sex is supposed to be enjoyable for you too. Okay. So let's talk about some reasons why the pain might be there and make sure that if you're having pain that you go see your doctor. Alright, so I'm going to talk about relatively five causes. I say relatively because the last one I'm kind of gonna lump together. Um, but first, one cause of pain with sex can be something called vulvo Dynia. And I'm also gonna kind of talk about these from like outer to inner, meaning more like vulva vagina causes, and then all the way to in the abdomen causes. So, first being vulvodynia. So vulvodynia is something that most people have never heard of before they see a gynecologist, but how it presents is usually you have some outer pain on your vulva. Most commonly it's at the opening of the vagina, just surrounding the opening, but it can be really anywhere on your vulva, and it feels like a burning or an irritation sensation. And it can cause pain while you're sitting down and pain during sex. Usually the vulva itself doesn't change in appearance. There's no like redness or change to the skin. Um, it's just the symptom that you're feeling. The way that we diagnose this is by an exam, and you'll kind of see a trend throughout this is that it's almost like a diagnosis of exclusion, which means we have to rule out everything else before we can just say that it's vulvo Dynia. So don't be surprised if your doctor gets imaging, gets swabs for infections and all that stuff, and all those things turn out to be negative because we have to check those things as well to make the actual diagnosis. But for vulvo Dynia specifically, it's a diagnosis on exam. There are certain points that your doctor can press either with their finger or with a Q tip that can elicit the same discomfort, burning, or irritation that you're feeling in that sensation. And if that is the case in the office, then we kind of have an idea that it is vulvodinia, in addition to ruling out all the other causes. So the exact reason why this happens is not really known. It's suggested or believed that it is some sort of nerve disorder or nerve pain in the area of the vulva that leads to these symptoms. And the way that we treat it is multifactorial, my favorite word. Um, that means that there's so many different ways we can try to treat it. Not always work for every single person, but there are different things to try. And I know one of the most frustrating things in medicine in general is you don't always go to the doctor and get the treatment and that's it. Sometimes there is a little bit of trial and error, which I know sucks, but we have to do that sometimes. So for vulvodynia, medications like antidepressants can help, and anti-seizure medications can help. Some antidepressants are actually applied to the vulva topically in a cream, and that's been shown to be beneficial for this possible nerve pain or nerve disorder of vulvodinia. Also, some topical numbing medication like lidocaine can work. Sometimes you will have injections to block the nerve pain. We call it nerve blocks that you have to get every so often. Hormone creams can sometimes help, like estrogen to the vagina. Antihistamines can sometimes help. Antihistamines are like Xyrtec, Claritin, they're allergy medications. Also, some pelvic floor physical therapy. So working with a pelvic floor physical therapist can be beneficial in a lot of these cases. I would usually tell people not just the medications, the creams, etc., etc., but to also do that at the same time as doing pelvic floor physical therapy. And then sometimes general therapy can help, like behavioral therapy, um, cognitive behavioral therapy, like a therapist that you talk to and you know, talk through the any concerns and problems that you have that can also be beneficial for helping to treat vulvodinia. So that is one of the conditions that can be causing pain with sex. Okay, so pain with sex cause number two that I'm gonna talk about today is vaginis. So we just talked about vulvodinia. Now this one is vaginis. I know. Weird names, probably never heard of them if you don't or have not been diagnosed with it, and they sound kind of similar sometimes. So vaginismus is actually a muscle spasm of the muscles of the vagina. So this can also be elicited in the doctor's office with an exam. Sometimes that's how we diagnose it. People with this condition also get really anxious before intercourse, and that's because it can be linked to past sex trauma, um, prior response to physical pain, um, getting a response to like a prior physical pain episode in your life. It can also be connected to mental health conditions. So a lot of people have anxiety with intercourse and are also diagnosed with vaginismus, um, kind of in conjunction with that. It can make just pain in general, it can also make sex just unable to be performed at all. It's almost like the vagina is closing off and the penis can't enter. So this condition, like I said, we diagnose it in the office on exam, also with your history sometimes. And again, we rule out all other causes. And treatment for this condition is use usually a combination of pelvic floor physical therapy as well as mental health counseling. So the pelvic floor physical therapy, you know, they work with dilators, they work with relaxation techniques, they work with um, you know, different things that they have at their disposal. Usually pelvic floor physical therapy, just so you know, is in a private room with a female pelvic uh floor physical therapist, trying to keep you the most comfortable, not just on the main floor with all the other physical therapy patients. Um, and then as well as counseling. So that is another condition, vaginismous, that can cause pain with sex. The third cause I want to touch on today is having an infection. So having an infection like an STD, such as gonorrhea, chlamydia, even herpes, um, even bacterial vaginosis and yeast, which are not STDs, can sometimes lead to pain, uh, painful sex, pain in the vagina. And, you know, these are a little bit more straightforward in diagnosis. We usually do either a urine test or a swab in the vagina to see if there's an infection there. Like I mentioned with the other conditions that I've talked about, plus the future conditions I will get to, we always rule out infection because it's easy to rule out or rule in, obviously, before we diagnose any of the other conditions. So this is something that your doctor will most likely test for just to make sure that it's just to see if it's there or not there, regardless of, you know, anything else, if you come in with painful sex as your main problem. So the way that we treat it, again, pretty straightforward. If it pops up positive for bacterial vaginosis, yeast or an SCD, we treat the specific condition with um medication. Some of those conditions, you know, like herpes, for example, are lifelong, but there are medications that can keep it at bay or keep it from coming out very frequently. And um, yeah, so problem number three with painful sex can be infection, and we rule it out most of the time when you come to the doctor's office with a painful sex concern. Okay, so the fourth condition I want to talk about that can lead to painful sex is vaginal dryness or vaginal atrophy. So vaginal dryness is, you know, more of the mild version. Vaginal atrophy is a little bit more severe version of vaginal dryness, but they feel like irritated or itchy in the vagina without being positive for an infection, is one of a common the common presentations. So we check for infection, rule that out, but similar symptoms. And you can feel the dryness kind of day-to-day, not always just with sex. Some people with vaginal dryness and vaginal atrophy also get more frequent UTIs. It can happen in women that are younger, more common in women that are older and post-menopausal. Also, I see a lot of vaginal dryness in women that are post-pregnancy or in the postpartum period, as your estrogen is a little bit lower at that time as well. So this can be an entry type of pain where it kind of hurts for sex when the penis enters the vagina right at the opening. And you can also feel a deeper pain as well, because the dryness is the whole vaginal canal. So kind of on the outside and deeper. The way that we diagnose it, again, we rule out infection and we examine you, we make sure we take a full look at the picture of the vagina. Vaginal atrophy and dryness, sometimes the vaginal canal doesn't look as pink and moist as it usually does when you're not having dryness. Um, it can look more pale pink, more white. And you know, we rule out all the other causes as well before we usually settle on that one. Treatment is lubricant with sex. So I usually tell my patients to try a water-based lubricant. If that doesn't work, you can try a silicone-based lubricant because it sticks around the vagina a little bit longer during intercourse, and that's during sex. You use that every time with sex. More long-term kind of maintenance medications, there are like vaginal suppositories. So there are non-hormonal suppositories that you can use. One example is uh hyaluronic acid, like you put on your face. There are suppositories that you could put that in the vagina to keep the collagen and moisture in the vagina. Another one that's hormonal would be vaginal estrogen that you can put in the vagina as a pill or a cream, etc. There are also oral medications that can be used to treat vaginal dryness, such as the medication called osphina. So there are many different ways that we can treat vaginal dryness or vaginal atrophy if that is the reason why you're having pain with sex. The final cause that I want to highlight today, like I mentioned, there are multiple causes, but this one's kind of gonna be lumped together as the intra-abdominal causes. So these are the people that come to me and they really have pain with deep penetration. The pain is more in their abdomen as opposed to in the vagina. So, yes, I still rule out all of the other causes. We do a history, we do a physical exam, we rule out infection, but um, I also will most likely get an imaging study of some sort, whether it's an ultrasound, a CT scan, etc., of the pelvis, because certain things, such as fibroids on the uterus, cysts on your ovaries, um, endometriosis, for example, can all cause deep kind of pelvic or lower abdominal pain when you have sex. So these are kind of the intra-abdominal causes that are the most common reason for this deep pelvic pain with intercourse. And of course, once we identify the finding, depending on what this finding is fibroid cyst, endometriosis, etc., we treat it based on the each diagnosis. So each one has a different treatment. And I have other podcast episodes where I specifically talk about fibroids, I specifically talk about ovarian cysts, and I specifically talk about endometriosis for its own full episode. So make sure you check those out if you're interested in treatments for those diagnoses. Yeah, so that is it for this episode. These are the five most common causes of pain with sex that I see in my practice every single day. I'm still a full-time OBGYN that I see patients. So these are things that I see really commonly, and um the things that I try to rule out or rule in depending on what's going on with each person that I see in the office. So if you are having pain with sex, like I mentioned in the beginning of this episode, do not think that that's normal. Do not think you have to grin and bear it. Sex is supposed to be fun for women and females too. So not just the men, okay? And there are many different treatments that we can try to make sex fun for you too, if you're having pain. So bring it up with your OBGYN and make sure that you get proper treatment, proper diagnosis, and start having fun with sex again. So that's it. Thank you guys so much for listening to the Four Vaginas Only podcast. I am Dr. Celestine. You can catch me at Four Vaginas Only on Instagram. You can go to my website, four vaginasonly.com, and I will see you guys on the next podcast episode. Bye.