Ep #41: Painful Sex

You are listening to The Midlife Sex Coach for Women™ Podcast, episode 41.

Welcome to The Midlife Sex Coach for Women™ Podcast, the only show that combines a fun personality, medical knowledge, sexual counseling, and life coaching together. To create unique sex coaching that helps busy women awaken their libidos, address intimacy issues, and learn how to express their sexuality for the rest of their days. Here is your host, certified life coach and sexual counselor, Dr. Sonia Wright.

Hello Diamonds. How are you all doing today? This week in Minneapolis, friends and family are getting together to celebrate Pride. And I just wanted to extend the love and well wishes to everyone listening to my podcast, so happy Pride. And as we celebrate Pride take the time to celebrate your uniqueness and hopefully take a moment to ponder how you could continue to make this a more accepting place for all individuals no matter what their sexual orientation may be.

Pride Month is about recognizing differences and embracing these differences because variety is an integral part of being human, human diversity. We’re not all alike. We don’t look alike. We don’t act alike. We don’t love all alike and that’s okay. So let’s take the time to see the beauty in each amazing individual. So for June and really the whole year I say, happy Pride everybody, enjoy the festivities whether they’re virtual or in person.

This week we are continuing to work on our month long deep dive into intimacy with an episode on painful sex which is also known as dyspareunia. I want to talk to women about experiencing pain with sex because it’s a topic that’s just not addressed. So many women do not feel comfortable talking about pain with sex. Often they think that there’s really only two options available to them. And that’s why I want to address this issue.

Women experiencing unwanted pain with sex often think that they either have to suck it up and ignore the pain, just tolerate it and hope that penetration will end quickly. Or they choose to close up shop altogether because they think that sexual intimacy is over. Since they’re having pain with sex they feel that that means that there’s no more sexual intimacy for them. They really feel like there’s no other options available.

I’ve personally talked to women who have been experiencing pain with sex for 20 and 30 years. And they think that it’s their wifely duty so they just lie down and take it. No one has told them that they have options. And I’ve also talked to women who have not had sex for 10 years or longer because it’s been painful. And then they go to this place where they’re not even getting any touch at all because they’re so afraid of sex. Well, I’m here to tell you that you do have options and we’ll get to what those options are.

But first let’s explore some of the common causes of painful sex. And since this topic is medical in nature my lawyer says it’s a good idea to have a disclaimer. So yes, I’m a medical doctor but I’m not specifically your medical doctor. The information that I’m saying here is general information that’s available to most people. That’s the end of the disclaimer.

So if you’re experiencing pain with sex go talk to your gynecologist, specifically one that focuses on sexual health and get the help that you need. Now let’s talk about some causes of pain with sex. About 75% of women experience pain with sex at some point in their life. And for some women that pain is infrequent while for other women the pain evolves into a chronic pain and it persists. And there can be many different causes of this pain. So the most common cause of pain is lack of lubrication, especially common in late perimenopausal and postmenopausal women.

And to be specific you’re considered postmenopausal when you’ve had 12 consecutive months without a period, the 13^th month then you’re a postmenopausal. There’s actually times also when premenopausal women live with the lack of lubrication and this can be an issue as well. So if a woman is breastfeeding or using contraceptive pills that basically puts the body into a mini postmenopausal state. Or just some women don’t produce a lot of lubrication just in general.

But all of these issues cause vaginal dryness which can lead to painful sex. And then a secondary issue as a result of this is you could end up with microtrauma or trauma to the vagina because of this lack of lubrication. And that microtrauma can set you up for infections as well. So this is something to be thinking about. And also the lack of lubrication can alter the flora in your vulva and vaginal area. And also the good bacteria can decrease in nature and that can also cause infections as well.

So always use a lubricant with sex and use much more than you think that you’re going to need and apply it more than once. So if you’re in the middle of penetrative sex and you start to feel discomfort you can stop and add more lubrication. There is no rule that you just add it once and that’s it. Add it as often as you need it.

And recognize that lubrication can be – it could be an oil, it could be a water based, it could be silicone based, it could be hybrid which is kind of a mix of water and silicone. It can be many different types and you can figure out what works well for you.

Another cause of pain with sex is pelvic floor dysfunction. And I think of the pelvic floor muscles as a group of muscles that nestle within the pelvic bone, almost in the shape of a bowl with the vagina and the anus sitting at the bottom of the bowl. If you interlace your fingers in a cupping orientation then you’ll have a similar concept of what the pelvic floor musculature looks like when it’s coming together. And you can also Google, pelvic floor muscles to get a better idea of what it looks like.

So in some cases the pelvic floor muscles, it may be too tight and this is what’s called vaginismus or spasming of the pelvic muscle floor, or the muscles can be too weak which can lead to incontinence. So you can have stress incontinence where you have some leakage with laughing and coughing or sneezing. Either way this can lead to dysfunction of the pelvic floor muscles and contribute to pain, especially when we’re talking about vaginismus.

With vaginismus the muscles can get so tight and it’s spasming so much that there’s no ability to penetrate the vagina. It’s like you’re up against a wall and there is no entry and this can be extremely painful. Pelvic floor physical therapy becomes something that’s necessary to deal with pelvic floor muscular dysfunction. And I mention that because it’s something that people don’t really know much about. And I want all my Diamonds to be aware of physical therapy for the pelvic floor.

If you’re having any leakage, any incontinence, if you’re having any issues at all with your pelvic floor, go to talk to your gynecologist and get a referral to a pelvic floor physical therapist. That is a special physical therapist that has special training in the pelvic floor muscles. And you could also find out more information at vaginismus.com. And we’ll put that in the show notes. And I’m also going to be interviewing a pelvic floor physical therapist so that we can talk more about this topic because I think that it’s very important and also one that’s not mentioned very often.

Okay, another cause of pain with sex is underlying conditions such as vulvodynia. Vulvodynia is a chronic pain associated with the vulva which would be the labia, the clitoris, the perianal region or it could be specifically pain associated with the opening of the vagina. And that area, that opening of the vagina is called the vestibule. So it would be vestibular pain. And this pain can be experienced as a stinging pain, a burning pain, a sharp stabbing pain, some itching and discomfort. It could be focal or it could be more diffuse.

So this is also something that’s important to talk to your gynecologist about and someone that specializes in sexual medicine and specifically pain. Now, don’t forget about infections when it comes to causes of pain with sex. So infections could be bacterial in nature such as an overgrowth of the bacteria, or it could be a yeast infection, or it could be a sexually transmitted disease such as Chlamydia or gonorrhea, but it’s important to think of the fact that infections also can lead to pain.

Structural anomalies can also lead to pain with sex. So if you have a large ovarian cyst, or a large fibroid, they can get really large and it can lead to pressure in the pelvis and it can lead to pain. If you’re having penetrative sex the penis could be basically hitting against the cyst or the fibroid and that could be causing some pain. Or the cyst or the fibroid could be pressing down and compressing the vagina. So that’s also something to take into consideration.

Now, deep penetration of the penis can also be an issue and it can also cause pain. It could bump up against the cervix or just bump up against an area within your vagina where the muscles in that region is pretty tight and kind of be a trigger point for you. So if deep penetration is an issue then changing positions would be helpful. You can try lying on your side with penetration or you can try positions where the woman is on top so you can have better control of the depth of your penetration.

And then there’s also a product called Ohnut which are like stacked silicone rings that are placed on the base of the penis and that decreases the overall depth of the penetration. So that might be something if you’re dealing with pain with penetration, that’s also something to think about.

Okay it’s time to get real. Listen up all you perimenopausal, menopausal and postmenopausal women let’s talk about this. Let’s talk about GSM, genitourinary syndrome of menopause. It’s a condition that results from a lack of estrogens and antigens, testosterone, women need testosterone too which affects the vulva, the vagina and the lower urinary tract. It’s a combination of postmenopausal symptoms which include dryness, and burning, and irritation. And it can also include sexual symptoms like lack of lubrication, pain with sex and atrophy of the genitalia.

Yes, you heard me say it, atrophy of the genitalia, the vagina can shorten in length and it can also shorten in diameter as well, get smaller in diameter. And so this can also contribute to pain. But there’s also another component which could involve urinary symptoms. So if you’re having urgency, dysuria, which would be pain with urination. Or you could have recurrent urinary tract infections.

So if you’re a postmenopausal woman and you suddenly feel like you’re having new symptoms of itching and burning, or maybe urinary tract infections every time you have sex or just in general, you may be dealing with GSM. So go talk to your doctors about it as well. And it may be the case that not all doctors know and understand about GSM. So once again we’re not really taught this information in medical school. So unless we’ve gone and gotten additional training or kept up on our reading then it may be the case that we don’t necessarily know as much about this.

But you need to advocate for yourself and recognize that this may be going on. Up to 63% of postmenopausal women deal with GSM. And I have to be honest here. I actually was dealing with this for probably close to a year. And I know about GSM and it didn’t even click in my mind that I was experiencing GSM. And then one day I was like, “Oh, you know what? I think that this is symptoms of GSM. You need to get yourself to the doctor and get it sorted out.”

So advocate for yourself. Recognize that this is a condition that can happen and just be aware of it. So what do we do now that we have some information on what might be causing the pain with sex? And that pain with sex does exist and that up to 75% of women encounter it at some point or another. First step, be willing to admit that you experience genital pain and pain with sex.

And then the next question is what do we do about it? So go see your doctor. And this is where I also have to acknowledge that vagina and vulva pain, and pain with sex can be difficult to diagnose and treat and also that the majority of doctors have not received adequate training to understand what’s happening to women. And honestly they may have actually gotten absolutely the wrong training and detrimental training where they’ve been taught that it’s psychosomatic in nature and that it’s all in women’s heads so be aware of this.

Unfortunately some doctors are not necessarily supportive, the majority are supportive and the majority will try and figure out what’s going on with you. But there may be some that don’t necessarily have the training or just not aware of what can happen for women. So if you’re experiencing pain and you’re not getting the help you need from your doctor then go find another doctor. You’ll need to advocate for yourself and you don’t want to get dismissed. You don’t want people to tell you, “It’s all in your head, don’t worry about it”, because that’s not going to help you.

So continue to look and see if you can find the right doctor for you. And make sure that you’re going to see a gynecologist, one that specializes in sexual medicine, not specifically a general practitioner. And if you can find one that has gotten additional training in sexual medicine as it relates to pain, that also would be important.

Some organizations which may be helpful in terms of finding a provider would be The International Pelvic Pain Society, The International Society for the Study of Vulva Vaginal Disease. International Society for the Study of Women’s Sexual Health, this is ISSWSH. And you can look at their website, it’s ISSWSH, you can look it up. And we’ll also put it in the show notes. They have a section on Find a Provider, that’s very helpful. There’s also The National Vulvodynia Association. So that’s something also to be aware of.

So whatever is happening it’s important to talk about it. You no longer have to live in silence. If you’re experiencing pain you have a right to get help with that. You have a right to not have to tolerate this pain. You don’t deserve that. And it is important to talk about it, talk about it with your partner, talk about it with your family, talk about it with friends, talk about it with a counselor, a therapist if you need one. Talk to your doctor, definitely and find support groups because this is something that’s really important.

As long as we don’t talk about this it’s going to remain a shameful thing hidden in the dark. And you’re my Diamond and you do not need to suffer in silence. There is hope for you. There is help for you. So reach out and get the treatment that you deserve. And I hear you if you have tried to get help in the past and it didn’t work. Try again, reach out, things have changed. There’s more information out there. You can get the help that you need. Treatment is available but it’s important that you don’t give up.

And while you’re getting your treatment it’s also important to take penetrative sex off the table. This is one of the first things that I do if a woman comes to me and she’s having a lot of pain with sex because it’s just confounding the issue. It is the ultimate negative feedback loop.

You’re in pain when you have sex so you avoid sex and intimacy. You stop touching, you stop connecting. The pain is associated with the fear of sexual intimacy. And then you’ll have thoughts around sexual intimacy. You’ll be thinking that sexual intimacy, if there’s even touch that that might lead to sex and then that’s going to be very painful. So then you start avoiding touch altogether, you withdraw from your partner. And the focus no longer is on pleasure when we’re talking about sexual intimacy. The focus is on survival and decreasing the pain as much as possible.

So then you try to have sex done as quickly and as soon as possible and get it over with and you’re no longer interested in pleasure, and connection, and satisfaction, and touch. So take penetrative off the table but do not take intimacy off the table. It’s more important than ever to enhance the intimacy while you’re getting the treatment for the pain with sex. And of course talk to your partner, no penetrative sex does not mean no intimacy.

It’s really important to keep the intimacy going. It’s really important to make sure that the pleasure is still there and the satisfaction is still there. I coach a number of women that have vulvodynia and dyspareunia, and they also have vaginismus. And my focus is always on making sure that the intimacy in the relationship is preserved and figuring out different ways to have sexual intimacy and sexual encounters. Which are not necessarily involving penetrative sex but does involve a lot of pleasure, and stimulation, and enjoyment for both partners.

And we are going to talk more about our thoughts in our minds related to painful sex and how to deal with these thoughts and how to sustain that intimacy while we’re experiencing issues with pain.

Okay Diamonds, until next time, Dr. Sonia out.

Diamonds, do you feel like you’re missing out on passionate intimacy and amazing pleasure even though your life looks fabulous to everybody else? Or maybe you feel like sex is just an obligation that’s on your to do list right after taking out the trash. Perhaps you would love to get rid of the story that plays again and again in your mind that sex is shameful. Or maybe you just want to want to want sex again.

Well, Diamonds let me tell you the time has come. My Own Your Sexuality Now 90 day program to greater intimacy and pleasure in your life is open for enrolment. In fact I’ve actually reorganized the structure of Own Your Sexuality Now so that you can join at any time. You don’t have to wait for a three month increment anymore. Just think, you can talk to me weekly and get all your coaching needs met in my anonymous weekly group coaching calls. And we have so much fun with these calls and we get the work done.

Best of all, you get a community of other women that are dealing with similar issues. You get to know that you are not alone. So this amazing program, Own Your Sexuality Now includes 12 self-paced modules that lead you on a journey to create the sexual intimacy of your dreams. You start from exploring concepts of you as a sexual being. And then you progress all the way to the point where you’re creating a pleasure plan, a unique pleasure plan for you that ensures that you get the pleasure and the sexual intimacy that you deserve.

And I’m so excited about this, and as a special bonus, Own Your Sexuality Now is going to include an additional three months of weekly group coaching calls and support from me, Dr. Sonia. So click on the link below, Diamonds, or visit my website www.soniawrightmd.com to find out more about Own Your Sexuality Now and to join. I can’t wait to see you all.

Alright Diamonds, that’s it from me, Dr. Sonia out.