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“Vulvar sexual pain disorders are often frustrating sexual pain disorders for treating physicians and always cause sexual dysfunction in those who suffer with them,” says Deborah Metzger, Ph.D., MD. Medical Director of Harmony Women’s Health in Los Altos, CA.
As a sex therapist, I wholeheartedly agree. One of the most common causes of low libido in my clients is as a result of painful intercourse.
After years of painful sex, spouses often need to be re-educated and re-introduced to each other in tender intimacy. A great deal of relational disruption has to be worked through in the couple as well as reactive anxiety resolved in the patient.
This can take time and requires the patient to be open-minded and honest. Two things are not always easy to do when struggling to understand the reality of what it is to live with a sexual pain disorder.
I’ve seen and heard plenty of experiences with painful intercourse. Some sexual pain disorders I’ve worked with are unusual. An example is when vulvar pain causes an apparent semi-aborted orgasm (a lacking of, or delay in the sexual climax) or clitoral pain upon arousal.
In addition to the unusual cases, I see much vestibulitis and vaginismus (both primary and secondary), vulvodynia, as well as garden-variety dyspareunia caused by rushed love-making technique or post-menopausal hormonal changes.
Let’s break down what each of these sexual pain disorders is.
Painful sex is more common than people want to assume. In fact, three out of four women have pain during intercourse at one point in their lives. There are two common types of sexual pain disorders; dyspareunia and vaginismus.
Vaginismus is an automatic reaction in the body to fear some or all types of vaginal penetration. Symptoms include a burning or stinging sensation at the vaginal opening when provoked by the insertion of any object. This can include harmless items such as tampons.
Typically, vaginismus is brought on following a lower genital tract infection and develops in women between the ages of 20 and 50. And can happen to women who have both had and not had sexual penetration.
Vulvodynia is an unexplained, yet persistent pain in the vulva, the female genitalia including the sensitive skin folds near the vaginal opening. This sexual pain disorder doesn’t discriminate when it comes to age as its counterpart can. What it does do is create long-term issues that are difficult to navigate for modern-day women.
Navigating these painful disorders can be tricky. And in some cases downright debilitating.
Suffering from Painful Sex
Pain reduction does not always increase sexual satisfaction for the woman. In fact, I think every postpartum woman should be considered for vaginal estrogen because of increased prolactin (even C-section patients) to ease the resumption of intercourse.
I would welcome any opportunity to be involved in a case conference regarding vulvar pain whether or not the patient makes an appointment with me.
Many of my clients are seen concurrently by pain experts at UNC, Chapel Hill, Division of Advanced Laparoscopy and Pelvic Pain. Physicians there have been successfully using a compound of .5mg/g estradiol and 5% HP lidocaine for many of my vestibulitis patients and have seen pain levels that have been 8-10 often for years sometimes drop down to a subjective 2-3 as early as 6 weeks into treatment.
The physicians there believe that even patients who do not have the typical presentation of vestibular erythema, the reported “burning” or “cutting” sensations respond to this hyper-estrogen (applied carefully only at the outer vestibule).
The cream, which is being compounded by a local pharmacy, is engineered to treat secondary vaginismus. Secondary vaginismus is when women experience fear regarding the pain of insertion during intercourse when they haven’t in previous years.
It is secondary vs primary because the woman has had sexual intercourse before vs being a virgin. Often this fear is inexplicable, but other times is justified based on a women’s previous sexual experiences.
Treatments for secondary vaginismus include sex therapy or counseling, physical therapy, and/or a vaginal dilator. The latter is a tubular device inserted into a vagina to help stretch the vaginal wall.
In one case where the MD chose to utilize physical therapy, she had patients use a vibrator to help reduce muscular tension. Often, curing sexual pain disorders requires a treatment triangle of physicians, physical therapists, and psychotherapists.
I work with clients to find sexual solutions and techniques that reduce painful intercourse, diminish anxiety, and increase patient control. In time, I invite the once-excluded partner to the sessions as well.
While a few clients have strictly organic pathology, many women find sex therapy for pain gives them an opportunity to resolve additional sexual problems from their past. Most are riddled with misinformation about relational feelings and experiences that might have further complicated their healing.