Pain during sex carries a lot of shame and embarrassment. It can be hard to understand; “What’s wrong with me? Why is this happening? Why now?” are common questions. In our culture, we generally believe that vaginal sex should ONLY be pleasurable, and, if it isn’t pleasurable, something must be wrong. More, sexual partners may feel confused, anxious and/or resentful. Consequently, you might shy away from discussing your experience with your partner, trusted friends or your medical provider. (Anal sex, on the other hand, is socially regarded as uncomfortable and, therefore, more socially acceptable to talk about the discomfort.) Still, painful sex is one of the most common complaints heard by gynecologists. Yet, most gynecologists rarely find medical reasons for the pain, leaving patients further frustrated.
Dyspareunia and Vaginismus
So what’s the deal? Dyspareunia is pain that occurs during penetration. This pain can be rather superficial or deep within the vagina. The causes can depend, too, on the location of the pain. For many, the pain can be directly tied to insufficient lubrication from too little foreplay. Also, aging can contribute to a thinning of the vaginal wall as estrogen decreases. Oh, and don’t forget that antihistamine that you take. Antihistamines not only dry your nasal cavity, they dry where ever mucus membranes are found, including your vagina! Still, others might experience pain caused by infections and/or inflammation; allergic reactions to creams, condoms, gels; as well as growths, such as cysts, tumors, or other conditions, such as endometriosis.
Vaginismus, a form of dyspareunia, involves the involuntary contractions of muscles around the opening of the vagina. Your medical provider will likely find no abnormalities in the genital region. As you can imagine, this condition makes it very painful, if not impossible, for a penis or other object to be inserted into the vagina. Because of the physical and emotional pain associated with vaginismus, it’s common that sex becomes something to be feared–pain is anticipated and the body braces for it. Sadly, this creates that vicious cycle where the body doesn’t learn how to relax. We’ll talk more about relaxation later.
Psychological Disorder or Pain Disorder?
Historically, many sexual health professionals viewed sexual discomfort of no known origin as a psychological disorder. Some continue to assume that these conditions are exclusively rooted in trauma, which may be unconscious to the person. However, more and more professionals view painful sex as a pain disorder, rather than a psychological disorder. The good news is that people find relief from painful sex and find more enjoyment out of sex by collaborating with a team of professionals and using psychological strategies.
The primary treatment strategy includes a multidisciplinary approach. As part of your treatment team, it’s imperative to have a sex therapist who will work closely with your gynecologist and a physical therapist specializing in pelvic floor work. Treatment will likely include psychoeducation and sexual health education, as well as physical and psychological exercises to support recovery. Treatment might also include the use desensitizing creams to reduce pain and/or dilators to retrain the muscles.
Progressive Muscle Relaxation
One important skill to learn for anyone dealing with pain is the ability to relax. There are a lot of strategies that you might find helpful, including gentle exercises, like yoga; as well as meditation or visualization; engaging in helpful, low stress hobbies such as art. Another invaluable skill is progressive muscle relaxation (PMR). PMR involves the paradoxical experience of tensing muscles in order to experience a relaxed state. Try it with me now. Take your hand and make a fist. Squeeze tightly and hold for a few seconds. Squeeze. Squeeze. And, relax. Let your hand go limp. What do you notice? Likely you’ll notice a shift in sensation.
PMR has long been used as a tool in treating pain disorders such as vaginismus. I’ve recorded a PMR session that you can follow and rehearse. Complete this daily. It’s a date with yourself. A well deserved date!
If you notice any pain in the genital region, it’s imperative that you see your medical provider. If no known cause is identified, your medical provider might recommend seeing a sex therapist and a pelvic floor specialist. We’re prepared to help you form your team and support your progress towards pain-free sex!