Reasons why sex hurts

There’s plenty of reasons why we should have sex, from helping us to look younger, boosting our immune system to getting a better night’s sleep. As well, of course, in feeling more connected with your partner.

But the growing list that scientists come up with of the physical and emotional benefits of getting frisky between the sheets, only serves to add pressure to women who find intercourse painful. Here’ when a doctor’s advice can help.

The 5 key causes of why sex hurts

1. Vaginal atrophy

Vaginal atrophy or dryness, also known as vulvo-vaginal atrophy (VVA) or atrophic vaginitis, is a condition that causes thinning, drying and shrinking of the tissues, of the vaginal walls due to your body producing less oestrogen. It can occur in the years leading up to the menopause. The condition also comes under the umbrella term Genitourinary Syndrome of Menopause (GSM).

Treatment might include vaginal moisturiser, or topical (vaginal) oestrogen – which can be applied directly applied to the vagina

A game-changing treatment is the MonaLisa Touch, which is a laser treatment for vulvo-vaginal atrophy has now been introduced with outstanding results. The MonaLisa Touch® laser therapy acts by reshaping and regenerating the atrophic vaginal tissue. It restores the healthy functionality of the vagina without the side effects of oestrogen. One study has shown improvements of 90% in vaginal laxity, 85% in vaginal itching, 84% in vaginal burning, 76% in dryness and 72% in pain during sex, after 3 sessions of MonaLisa Touch®.

2. Vaginismus

Vaginismus is an involuntary tightening of muscles around the vagina whenever penetration is tried. Sufferers can have their sex life totally disrupted, and when intercourse can happen it is often painful.

Treatment is often in the form of psychotherapy to look into any past traumas that may be causing the problem. Dr Dmitri Popelyuk is a consultant psychiatrist and expert in psychosexual medicine. ‘Nobody should let embarrassment stand in the way of their health and emotional wellbeing,’ he assures. ‘I am all about treating my patients holistically.’

3. Vaginitis

Vaginitis is a condition caused by painful inflammation of the vagina, and sometimes the vulva too. Vaginitis is often the result of an infection with yeast, bacteria, but it may also be caused by physical or chemical irritation. Trichomonas Vaginalis, is where the inflammation in the vagina is caused by one of the most common sexually transmitted diseases (STDs). In women the symptoms include vaginal discharge, genital itching, pain on passing urine and lower abdominal pain. Men may have no symptoms, while some may have signs of penile discharge and pain on passing urine.

Treatment for all types of vaginalis is usually with an antibiotic called metronidazole – which can be given as a single high dose treatment or over the course of 1 week.

Dr Amarjit Raindi, a GP with expertise in gynaecology, advises that, ‘Any patient testing positive should also be screened for other sexually transmitted infections as they can often co-exist.’ 

4. Vaginal prolapse

Vaginal prolapse tends to occur in women over 40, and is where the complex muscles that support the structure of the vagina weaken and result in the collapse of areas of the vaginal wall. This is a relatively common problem that most women will experience to a degree in their lifetime. The key triggers are following childbirth, menopause and hysterectomy. Symptoms can include a dragging feeling, as if something is protruding or a bulge in the wall of your vagina. There may be difficult with bowel movements or incontinence. In some cases the opening to the vagina gapes open.

Treatment may initially be in practising your pelvic floor exercises – by simply stopping your urine mid-flow, or tensing and releasing the muscles inside the vagina. Miss Tania Adib, a consultant gynaecologist at Twenty-five Harley Street, says, ‘If you can experience discomfort when standing, coughing or straining. You may also have pain on intercourse or recurrent urine infections. This may indicate that the pelvic floor is not so well supported, so either the womb, the bladder or rectum are bulging into the vagina, a prolapse.

‘Keep a healthy body weight to prevent pressure in the vagina. Pelvic floor exercise and Kegel exercises help strengthen the pelvic floor muscles, however it’s important to seek out advice from a consultant gynaecologist to get a suitable treatment strategy.’ 

Hormone replacement therapy (HRT) can relieve some of the symptoms associated with prolapse, such as discomfort during sex and dryness. However, in more advanced cases a rubber or silicone vaginal ring pessary may be inserted to hold the prolapse back. In some cases, surgery will be required.

5. Lack of arousal

A loss of sexual desire can affect men and women at any time in their life. However women may experience this as a result of hormonal shifts following childbirth or during menopause. The main cause of this problem is usually down to psychological rather than physical factors, such as stress, anxiety or trauma such as bereavement.

Treatment can be given in way of counselling in order to help resolve any underlying emotional problems. Consultant psychiatrist Dr Dmitri Popelyuk says, ‘Sexual issues are often an intricate relationship of both emotional, mental and physical issues. Untangling these will get to the root of the issue, and allow women to enjoy sex once again.’

You may also find it beneficial to use your diet to help balance your hormones.  Eating sugary foods causes huge swings in blood glucose triggering symptoms similar to menopause, compounding the problem. Try using food to keep your sugar levels steady, such as eating:

• Good fats such as those found in salmon
• Complex carbohydrates
• Fresh vegetables and fruit to stay hydrated
• Tofu, soya, red clover, alfalfa, flaxseed and dandelion all include phytoestrogens - weak plant oestrogens.

Miss Stephanie Moore, a clinical nutritionist, runs a clinic at Twenty-Five Harley Street, and specialises in nutritional medicine to balance hormones.