Pain during sex? What women need to know

Sex is supposed to feel good. But for many women -- both young and old -- sexual intercourse can be painful.

According to the Center for Sexual Health Promotion at Indiana University, up to 30 percent of women aged 18 to 59 experience some type of pain during sex in their lifetimes, compared with just 5 percent of men. Post-menopausal women are more likely to suffer from it than young women, but it can happen at any age for a variety of reasons.

"There are some problems that are so embarrassing, it's hard for people to talk about them even with their doctors. For women one of those problems is pelvic pain and pain during intercourse," noted CBS News chief medical correspondent Dr. Jon LaPook in conversation with Dr. Lori Warren, a gynecologist and a partner with Women First of Louisville.

Warren urged women to talk with their doctor if they are experiencing pain during sex, since the condition is so common and often very treatable.

She said the first step in helping her patients is to seek out the root cause for the pain. Painful sex, also known as dyspareunia, may be a symptom of a larger health problem, and can also be linked to a number of physiological and psychological factors.

Acute infections -- such as yeast or bacterial infections, gonorrhea and chlamydia -- can often cause painful sex, and can be treated with prescription medications.

But more often, Warren will diagnose a patient with either vulvodynia or vaginismus.

Vulvodynia is pain that originates from the vulva, which is the opening of the vagina including the labia minora and majora. "It's usually due to the sensitivity of the nerves and it can very difficult to diagnose," Warren explained. "It causes almost a chronic or constant burning or raw feeling."

Warren added that gynecologists often will not recognize it and mistreat a patient for conditions such as yeast infections instead. Sadly, this makes vulvodynia a chronic condition for many women. According to a Harvard study, funded by the National Institutes of Health, up to 16 percent of women in the U.S. suffer from the condition at some point in life, and 90 percent of them experience pain for years.

Multiple treatment options exist for vulvodynia. For example, there are medications available that can help to desensitize nerves. These include a number of tricyclic antidepressants such as Tofranil (imipramine) and Anafranil (clomipramine) or newer antidepressants such as Cymbalta (duloxetine). Certain anticonvulsants like Neurontin (gabapentin) and drugs used for neurologic pain, such as Lyrica (pregabalin), often are prescribed for vulvodynia.

Certain topical anesthetic creams or gels can help numb pain as needed. Some older women do well with vaginal estrogen cream if the pain is associated with thinning of the vaginal wall and dryness, which occurs from estrogen loss during menopause.

For a small number of women, painful sex is due to a tight hymenal ring, and a minor surgical procedure may be required to open the hymen. Loosening the hymen can make intercourse possible for some women and help to decrease pain during sex.

Painful sex in women is also sometimes linked to a chronic condition known as vaginismus, a tightening of the pelvic floor muscles, which are muscles that support the vagina and other reproductive and digestive organs in the lower abdomen.

Warren often refers a patient to physical therapy if the pain during sex is related to pelvic floor muscle problems, and some physical therapists specialize in helping women with dyspareunia.

Sometimes the discomfort is made worse simply because a woman anticipates that sex will be painful. "You're going to involuntarily tighten up your muscles and that actually is a vicious cycle because if you tighten up your muscles then it makes the nerve pain worse," she explained.

Additionally, some psychological factors can be linked to painful sex, said Warren. A woman may have depression or anxiety or have difficulties in her relationship that make sex emotionally -- and therefore physically -- challenging. And for some women, dyspareunia may be related to post-trauma from past physical or sexual abuse.

If a patient needs to address any psychological issues associated with painful sex, there are a number of options, she says. Cognitive behavior therapy and biofeedback may be helpful. Some psychologists specialize in sexual health.

In other cases, pain during intercourse can be felt further inside a woman's reproductive system, and this may indicate a more serious health condition. "If they're having deeper painful sex, it could be due to problems with their pelvic organs, with their uterus and their ovaries," said Warren. The pain may be linked to endometriosis, a disorder in which uterine cells proliferate in other areas of the body and can lead to irregular bleeding, infertility and chronic pain.

Warren urged women to talk with their doctor if they are experiencing pain during sex, since the condition is so common and often very treatable -- and to keep trying until they find the help they need.

"Sometimes they're frustrated and they've been looking for treatment and maybe they've been from doctor to doctor to doctor and they're not getting any answers," said Warren, who is also a founder of passthepearls.org, a non-profit organization that educates about women's health and gynecologic surgery options.

"Sometimes they're just embarrassed because they feel that they're not normal and that this shouldn't be painful for them. Sometimes it's really affecting their relationship with their partner. So you have to take all of those things into consideration."

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