What do I do when sex hurts?

Amazing sex always appears to be a piece of cake in the movies. However, real-life sex might provide us with unexpected challenges, such as pain that interferes with situations we had previously expected to be entirely pleasurable.

Many people avoid talking about painful sex since it can be uncomfortable, even with a doctor. But if you're struggling with it, you're not alone. According to the American College of Obstetricians and Gynaecologists, discomfort during intercourse is incredibly frequent, with over three-quarters of women feeling pain at some point in their lives. Additionally, up to 60% of women report having painful sex in the run-up to menopause and afterwards.

Strong research shows that women often don't share this concern with their health care providers unless they're specifically asked, and doctors rarely ask

What makes sexual activity painful? It could involve burning, soreness, dryness, or a general feeling of discomfort in addition to the actual jabs or twinges of pain. Although it can affect nearby areas, including the pelvis and lower back, it is often most visible in the vagina and vulva. Sexual activity with partners of either gender can also cause pain.

You don't have to accept painful sex, though. It's time to look at why pleasure becomes discomfort and figure out how to restore enjoyment to the bedroom. Physical intimacy is important for couples.

Why may sex become uncomfortable after years of usually pleasurable lovemaking? Your stage of life is a major contributing factor, but there are many other important elements as well. Gynecologic disorders such as pelvic inflammatory disease, endometriosis, ovarian cysts, and fibroids may play a role. As well as other medical conditions like arthritis, radiation, pelvic surgery, or cancer. Even the thought of having sex can be impossible for someone with vulvodynia, a persistent pain illness affecting the vulva.

The following scenarios account for the most painful sex instances:

Childbirth. Undoubtedly, giving birth vaginally is difficult for the vagina, perhaps even more so for women who have undergone an episiotomy or perineal tears. The healing process can take several months. Vaginal dryness can be exacerbated by hormonal changes during childbirth and breastfeeding.

Menopause. A chronic, increasing absence of natural vaginal lubrication can be brought on by declining estrogen levels during the years preceding menopause and after. It typically starts with a sense of dryness or soreness low in the vagina, but over time it can become really uncomfortable everywhere.

High pelvic floor tone (Hypertonic). After a stressful experience, like a sexual assault, the muscles surrounding the vaginal opening may automatically constrict. Ironically, however, the disease might even start with the thought of discomfort in the bedroom. The more you expect sex to hurt, the more your pelvic floor muscles tense, creating a vicious cycle. Your pelvic floor muscles contract whenever intercourse is attempted, making sex even more uncomfortable. It's almost like your body is attempting to protect you. There may seem to be a wall there.

How to increase comfort

If you're afraid it'll hurt, sex can lose its appeal. The proverb "use it or lose it" is not applicable in this instance, however, as having less sex as menopause approaches does not increase the likelihood of painful intercourse.

2,247 women, aged 42 to 52, who reported no sexual pain at the trial's start and consented to log their sexual frequency and symptoms participated in the study, which was published on June 1st, 2022, in Obstetrics and Gynaecology. Over the course of up to 10 follow-up visits over the next 13 years, nearly half of the participants reported experiencing pain during sex at least occasionally. While having oral sex or being aroused more frequently (with or without sexual activity) were connected to lower odds of experiencing sexual pain, vaginal dryness revealed the highest association. But it wasn't taken into account how much sex the women had.

There are thoughts that intercourse is good for the vagina, stretching it and bringing in secretions and blood flow however, there is no data to back this up.

A gynecologist's appointment, which should include a full history and a pelvic exam if painful sex is frequent or severe. If you are having severe pelvic sexual pain, an ultrasound might be necessary. However, the examination and your explanations will help to make the diagnosis and determine the best course of action. The following are some of the most typical choices:

Lubricants. When the vagina is penetrated, these can minimise friction, discomfort, and sensitivity. Many are available without a prescription, including treatments that dissolve in water and variants made of silicone that last longer and are often more slippery. Even cooking oils like coconut or olive oil can have a dual purpose in the bedroom. Make sure it's hypoallergenic and free of any flavours or colours that can irritate your tissues, no matter what you decide. Avoid mineral oil, petroleum jelly, and baby oil if you're also using condoms because they can cause cracks.

Moisturisers for the vagina. As opposed to lubricants, which merely make the passage more slippery, these products cause the cells in the vagina to draw in water. It's like moisturising your hands or your face. The majority are long-acting and intended for daily use.

Vaginal estrogen. When weakening tissues inside the vagina are coated with a prescription estrogen medication, wetness and comfort during sex are increased. It comes in a variety of forms, including creams and suppositories that are applied sporadically each week. A soft, flexible oestrogen ring (Estring) that constantly releases minuscule amounts of the hormone over a three-month period is a longer-acting option. While prescription oestrogens can be costly, they are generally thought to be very safe. They avoid the possible health concerns of higher-dose systemic hormone therapy used to treat hot flashes and other menopause symptoms because they don't increase blood oestrogen levels.

Pilates for the pelvic floor.

Numerous therapists are qualified to concentrate just on the pelvic floor, providing women with exercises to calm the pelvic floor muscles and stretching or strengthening the tissues as necessary. Women who experience unpleasant sex and pelvic pain and don't respond to previous treatments.

Sometimes stretching your mind is the best exercise for sexual comfort. Think about alternative ways to give and receive pleasure. Sex should be broadly defined and can be enjoyable without penetration. As the years go by many women and couples engage in sex involving the external genitals or oral activities.