Painful Intercourse (Dyspareunia) and Vaginismus
Two fairly common female sexual problems are painful intercourse and vaginismus, where the vaginal muscles involuntarily clamp down out of fear of physical and/or emotional pain, which does not allow intercourse to occur. These problems may have physical, mental and relationship causes.
Sometimes a woman has a vaginal infection or another physical issue such as endometriosis, which are internal adhesions between organs, which can cause pain during intercourse. She may also have fibroid tumors or other medical problems that are best diagnosed by a gynecologist.
Painful intercourse and vaginismus are treated by a gynecologist, sometimes with a physical therapist who specializes in pelvic floor dysfunction and pain, in conjunction with a board certified sex therapist. I refer to gynecologists and physical therapists. The team approach is the only really effective way to solve these problems of female pain.
Sometimes a woman confuses emotional pain with physical pain. She may anticipate pain because she has felt it in the past. She may be hurting emotionally, which can affect a lack of lubrication, resulting in more pain.
The male partner must be sensitive and patient to solve his partner’s pain disorder. He is often included in meetings with the gynecologist and the physical therapist, as well as with me. Effective and clear coordination between the three professionals is absolutely essential. I like to help coordinate these complementary efforts.
Some men feel pain during intercourse or oral sex too. Sometimes men with a long foreskin from not being circumcised feel pain and discomfort. There are several treatments from urologists for such pain, but I also give suggestions that may minimize any pain. I work with urologists to solve these male pain and discomfort conditions. Once again, the team approach is the only truly effective way to solve sexual issues.
In some cases, both lovers feel pain during intercourse. I suggest specific lubricants, and I work with doctors as appropriate. Positions of intercourse and other lovemaking issues must be focused on to solve these problems.
Intercourse following childbirth can sometimes be painful at first. Fatigue and sometimes postpartum depression affect many new mothers’ desire for and enjoyment of lovemaking. Resentments about the impact of the birth on a couple’s sex life are best dealt with in a board certified sex therapist. Couples can profit from working with me to adjust to the physical and relationship stressors that can affect a harmonious sex life after the birth. Patience is a virtue! It is important not to make intercourse the only sexual or intimate expression of love. I often work with young couples with these issues.