Painful Sex

Pain with sex can be an extremely distressing condition.

It can affect the way a woman feels about herself, her ability to have a satisfying sex life and can also cause major difficulties within relationships.

Some women may feel embarrassed to talk about it or don’t know where to seek help and others may feel that if they simply ignore it, the pain might go away. Unfortunately, the longer you leave it, the more likely it will usually get worse. Having the courage to talk to someone about the issue is always the biggest and most important step.

There are many causes for painful sex which can include:

• Endometriosis
• Pelvic floor dysfunction (tight and tense vaginal muscles)
• Vulval skin disorders such as lichen sclerosis
• Chronic thrush
• Vaginal and vulval changes of menopause and other hormone treatments such as the pill
• Pelvic or vaginal infection
• Psychological factors and history of sexual trauma

Often these conditions can overlap. When pain persists, anxiety relating to having sex increases, which causes pelvic floor muscles to become even more tense and then pain can become worse, precipitating a vicious cycle of anxiety and pain.

At Eve Health, we have gynaecologists who specialise in helping to find and correct the initial cause of your pain and will then work with you alongside our physiotherapists to help to retrain your pelvic floor muscles so that sex becomes comfortable and even enjoyable again.

What will happen at your first visit

Your first appointment will be a long appointment to allow adequate time to get to know you and understand your issue.  You may be feeling fearful or worried about discussing such personal and intimate issues as sex, but rest assured, the Eve Health gynaecologists are sensitive and caring, and will provide you with the space and understanding to open up. After we have obtained a thorough medical history from you, it may be appropriate to perform a gentle internal examination and an internal ultrasound.  The purpose of this is to check the vulval and vaginal skin for any signs of skin conditions or infection that could be causing your pain, examine the muscles in the pelvic floor to check for dysfunction and tension, and also check your cervix, uterus and ovaries for any signs of endometriosis or ovarian cysts. Any examination will only take place with your consent.

After we have pieced all the information together, we will come up with a plan to tackle your unique issue. Firstly, we treat the underlying cause and then work on down-regulating the pelvic floor.  We work closely with our Allied Health team and have a team of highly experienced and skilled women’s health physiotherapists who will help to relax your pelvic floor if this is an issue with you.

Sometimes we recommend seeing our physiotherapists regularly over a few months, in addition to doing daily exercises at home.  Some women do very well with the use of vaginal dilators (a set of tube-shaped devices used to help the muscles relax) and our physiotherapists will guide you through this process.

If there is an underlying skin or hormonal issue causing vulval pain, we sometimes recommend treatment with topical creams to help improve skin health and integrity before commencing physiotherapy. Sometimes it may be appropriate to have a break from hormonal contraceptive if this is part of the issue.

It is important to remember that it has often taken months or even years for your pain with sex to develop, and so it can take some time to improve things.  Rest assured, that there are effective treatments and with the right support, most women get better and can enjoy sex again.  If you require help with painful sex, please come and see our team at Eve Health, and start on the road to recovery.