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 hypertonia (tight and tense vaginal muscles)

  • Vulval skin disorders such as lichen sclerosis

  • Chronic thrush

  • Vaginal and vulval changes of menopause and other hormone treatments

  • 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. It is important to ask detailed questions to find and correct the initial cause of your pain.  This can feel embarrassing but it is important so that we can work together on a plan so that sex becomes comfortable and even enjoyable again.

Sometimes the recommendation is to see a  physiotherapist who specialises in women’s health 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).

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.