Painful sex: A common female health problem

Question: What is one of the biggest issues facing women's sexual health?

Answer: Pain with sex is a major health problem for women. The incidence is about 8 percent (anywhere between 3 percent and 15 percent depending on the study). This about the same incidence of asthma, so it is a common problem. It affects sexual fulfilment, can contribute to relationship issues, and affect a woman's self-esteem.

Question: I had no idea it is so common

Answer: Sadly many women suffer in silence. Our culture is filled with misperceptions and taboos concerning women's sexuality. My own mother can't tell people that I am gynecologist because it "isn't nice". Many women mistakenly believe that pain with sex is normal, that it is supposed to hurt. Some don't have the courage to broach the subject and sadly many who do speak up are dismissed by their physicians. Some are told it is "all in your head" or "have a glass of wine before" and others are misdiagnosed with chronic yeast infections.

Men have all those erectile dysfunction ads on Tv to raise awareness, but there are no ads on TV to raise awareness for women. The only TV character to ever have pain with sex was Charlotte from Sex in the City, and I think that was a brief secondary storyline. If no one talks about it, you think you are the only one.

Question: What are the causes?

Answer: Dyspareunia, which is the medical term for painful sex has many causes. You have to think about the anatomical structures that are involved in sex. (Bring out model if allowed). For some women it is a lubrication issue. This is more common among post menopausal women as many choose not to take hormones. Another common cause is nerve pain, a condition called vulvodynia is common. Typically the pain is more insertional. The pelvic muscles can also be involved (will show on model). These muscles wrap around the vagina and can cause severe pain both with insertion and deeper penetration. Bladder inflammation, skin conditions, and even endometriosis ( a condition where the lining of the uterus grows in abnormal locations) can also cause painful sex.

Question: What should a woman do if she is experiencing painful sex?

Answer: The first thing is to understand that pain with sex is not normal. See your doctor. Think about what makes it hurt and about any other pain you may have in the area that is not sexually related (like pain emptying your bladder). Pay attention to your menstrual cycle and see if there is any relationship. This is all helpful information. Tell your doctor if you have pain other times as well (like from your clothes touching your skin).

Insist on a diagnosis or referral to someone who can give you a diagnosis. Most of the conditions that cause pain with sex are diagnosed by history and by exam. If a skin condition is suspected a biopsy may be needed.

Question: What if her physician poo poos the notion?

A: get another one! The national vulvodynia association is a great resource to find doctors with knowledge in the area.

Question: Can you give us some starting points for at home?

Answer: Besides thinking about when it hurts and other pains in the pelvic area, stop removing pubic hair. It is there for a reason, It protects the delicate genital skin and the process of removing hair, no matter the method, is irritating. Stop putting soaps on the vulva. I tell patients the vulva is like a self-cleaning oven, chemicals are actually damaging and strip away the natural oils. Plant based or botanical isn't any safer. Tea tree oil for example can cause skin reactions and sensitive your skin making it more vulnerable.

Use a silicone based lubricant. If that is irritating you can even use olive oil. Consider using all cotton menstrual pads.

And don't be afraid to speak up. Having a good sex life is your right. Practice what you are going to say to your doctor in the mirror before your appointment. Get comfortable saying it. You should be able to tell your doctor anything and everything and they in return should listen and help you.

You can also keep up with Dr. Gunter, San Francisco's Sexual Health Examiner at or follow her on Twitter @drjengunter

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