Painful sex

In a perfect world, sex would feel amazing all of the time. In real life, sex can be painful—especially for women. Talk about a mood killer, right? Many people suffer in silence, not knowing that this experience is incredibly common. There’s even a name for it: dyspareunia. Dyspareunia, aka pain during sex, can occur for a whole slew of reasons, from physical (irritation, inflammation, injury, muscle spasms, or simply a lack of adequate lubrication resulting from not enough foreplay, certain medications, or hormonal changes) to psychological and emotional (anxiety, depression, or stress). Deep pain can be a symptom of conditions such as endometriosis, pelvic inflammatory disease, irritable bowel syndrome, or an ovarian cyst, or be related to scarring from a pelvic surgery. No matter the cause of painful sex, it’s not something you should have to suffer through, and it’s definitely not something to feel ashamed about. It’s hard when an activity that used to be enjoyable turns into something you dread. Persistently painful sex can do a number on your relationship with a partner, who may feel rejected if you're never in the mood. It can also change your relationship to your own body—intimacy doesn’t always involve another person! If you are experiencing painful sex, you and your partner can try to mix up your sexual routine to minimize any pain. For example, try a different position, openly communicate about what feels good and what doesn’t, don’t rush (longer foreplay=better natural lubrication!), or try a personal lubricant. You may find other ways to be intimate. (It’s not always about intercourse.) If these options don’t help, talk to a practitioner you trust who can do a thorough history and exam. Treatment options depend on what’s causing your discomfort. If it is due to a medication, stopping or switching can help. Lubrication can be improved with topical hormones (if your problem is related to hormonal changes with age). There are also prescription meds that may help, like ospemifene. Desensitization therapy, which includes vaginal relaxation exercises, is also an option. Keep in mind the approach to treatment is not just about the body. Counseling and/or sex therapy help many people with sexual health issues, and cognitive behavioral therapy is a go-to way to help change any negative thoughts or behaviors. Bottom line: painful sex is complicated, but there are solutions. That's why you should discuss the matter with a caring, experienced practitioner. They’ll have a better idea whether the issue is physical or psychological—or both—and they can help you get back to enjoying intimacy again.