Painful Sex: Genito-Pelvic Pain/Penetration Disorder
At some point in their life, most women will experience pain during or after sex. Female pelvic or sexual pain is a widespread problem, affecting 3 out of 4 women at some point in life. People of all genders and sexualities can experience painful sex; however, most research focuses on heterosexual women, so this article refers primarily to female sexual pain. Painful sex can be caused by a number of different medical conditions that affect the reproductive organs, including pelvic inflammatory disease, ovarian cysts, endometriosis, and sexually-transmitted infections. When the cause of sexual pain is unclear, it is usually diagnosed as Genito-Pelvic Pain/Penetration Disorder.
Genito-Pelvic Pain/Penetration Disorder is a relatively new diagnosis that replaced older categories of sexual pain. Diagnosis requires a history of recurrent pain, difficulty, or discomfort with vaginal penetration lasting 6 months or more, that isn't better explained by another medical or mental health condition. You may also be diagnosed with Genito-Pelvic Pain/Penetration Disorder if you experiencing significant fear or anxiety before or during penetration, or a noticeable tensing or tightening of the pelvic floor muscles when penetration is attempted. Genito-Pelvic Pain/Penetration Disorder may be lifelong (present since the beginning of sexual activity), or acquired (beginning after a period of comfortable, painless sexual activity). The severity of the disorder can range from mild to severe depending on the level of distress and discomfort it causes.
There are several different types of female sexual pain. Although these different types of pain used to be known distinct diagnoses, they now fall under the umbrella diagnosis of Genito-Pelvic Pain/Penetration Disorder. Some women experience pain during or after vaginal penetration, either in the vulva, vagina, or deep inside the pelvic region. Others experience a tightening of the pelvic floor muscles that causes pain with attempted penetration, leads to fear or anxiety about sex, and may make penetration impossible. The four most common types of sexual pain are:
- Persistent, recurrent pain with vaginal penetration or intercourse.
- May be experienced externally in the vulva, within the vagina, or deep in the pelvic area.
- Often results from a medical condition, and is the most common in women after childbirth.
- Persistent, recurrent difficulty allowing vaginal penetration.
- Not specific to sex- often includes discomfort during gynecological exams or when using tampons.
- Often caused by involuntary contraction of the pelvic floors muscles surrounding the vagina.
- May cause or be caused by genital pain or fear of penetration.
- Recurrent burning pain in the vulva, with no apparent physical cause.
- May be either widespread or localized, causing pain in a specific area.
- Most common type of localized vulvodynia.
- Chronic recurrent pain specific to the tissue around the opening (vestibule) of the vagina.
- Triggered by touching the area, either during penetration or with a tampon or finger.
Painful sex can have a significant effect on your mood, causing depression, anxiety, shame, or fear of pain. If sexual pain prevents you from having sex, you may feel frustrated, humiliated, or guilty, while your partner may feel rejected, unwanted, or undesirable. The stress of chronic sexual pain can cause difficulties with other areas of sexuality, including desire, arousal, and orgasm. This can lead to a lack of pleasurable, enjoyable sex, and even affect the quality of your relationship. Your sexual frequency may decrease significantly, and you might even find yourself or your partner avoiding intimacy entirely. When sex becomes a sensitive issue for a couple, it can be easier to avoid kissing or touching altogether than to risk an upsetting attempt at sex.
Although sexual pain can feel overwhelming and impossible to overcome, there are lots of things you can try to treat the issue:
- Visit the Gynecologist: When you are experiencing sexual pain, it is important to visit a doctor to make sure that there isn't a clear physical cause. Before attempting other ways to manage sexual pain, rule out cysts, infections, or conditions that could cause pain during sex. Medical conditions like endometriosis, ovarian cysts, yeast infections, or sexually transmitted infections may be responsible for sexual pain. If possible, choose a gynecologist with experience diagnosing and treating pelvic and sexual pain, who may be able to give you a more comprehensive examination.
- Create a Sexy Environment: Too often, we use our bedrooms as another place to work, watch TV, eat dinner, and other un-sexy activities. To turn the bedroom into a place that invites sex, create a bedroom environment that feels luxurious, comfortable, and stimulating to all your senses. Give your bed a sensual make-over, with cool satin sheets in the summer or cozy flannel in the winter. Sink into soft pillows and a plush comforter. Add scented candles, essential oils, or cologne to stimulate your sense of smell, and sultry music to set the mood. Finally, if your bedroom gets cold in the winter, invest in a quiet space heater to warm things up- it's hard to feel sexy when you're shivering.
- Increase Your Arousal: It's hard to feel sexy when you're nervous, anxious, or uncomfortable. Over time, chronic sexual pain leads to a cycle of anticipation of pain that creates fear and inhibits arousal, making attempts at sex even more uncomfortable. Make a list of things that you find arousing: sexy lingerie, candles, a bubble bath, soft sheets, fantasy. Maybe you like things a little more adventurous: blindfolds, spankings, and light bondage can be arousing for many people. Experiment with different sensations and stimuli, and learn what turns you on. It's important to re-learn how to feel aroused without anticipating or fearing pain or discomfort.
- Stick with Feel-Good Activities: One of the first goals of treating painful sex is stopping the cycle of fear and pain. In order to do this, your body and brain need to begin to associate sex with pleasure rather than discomfort. For a while, commit to only doing sexual activities that don't cause pain, and let yourself enjoy the sensations. This will look different for every couple: some couples might stick to back massages or making out, while others might experiment with mutual masturbation, oral sex, or sex toys. Find your comfort zone, and stay there for a while before adding in something new.
- Go Slow: Don't jump right back in to penetration if that's the biggest source of your sexual pain. Start with oral sex and other comfortable activities to create as much arousal as possible, then slowly add in penetration with fingers or small sex toys. Work your way up, slowly increasing the size of the object you're penetrating with (fingers, dilators, or sex toys) until you're comfortable trying penetrative sex with a penis. When you feel ready to try penetrative sex (or any other previously-painful activity), it's important to first make sure you are physically turned on. Insufficient arousal before penetration is a major cause of painful sex, and if you're not going slowly and engaging in other stimulating, arousing activities, lack of natural lubrication can impact your sexual success. Learn your body, and what arouses you, and start with those activities to warm up before attempting penetration. Take your time!
- Try Lubrication: If you find that your natural wetness when aroused still isn't sufficient for comfortable penetration, try adding in a lubricant to decrease friction. While many people never use lube, some people don't naturally lubricate enough for comfortable penetration; every body reacts differently to arousal, and hormone levels, chronic illnesses, and medications can all impact natural lubrication. Before relying solely on artificial lube, give yourself time to experiment with different activities with and without lube, to learn how your body naturally responds to arousal. A little extra wetness never hurts, especially when dealing with painful sex, as the anxiety and anticipation of pain can inhibit the natural lubrication that comes with arousal. Look for lubes that are body-friendly: free of glycerine, parabens, and other irritants. Experiment with different types and amounts of lube, until you find what works with your body and your partner.
If the self-help strategies listed above don't help, it may be time to seek help from a professional sex therapist. Although female sexual pain is a common problem, studies show that nearly 40% of women with sexual pain never seek treatment for their discomfort. If you are experiencing painful sex, the Center for Growth can help. Call 267-324-9564 to speak with a Philadelphia therapist experienced in treating sexual pain.