April 27, 2008

marjorie-green"If your gynecologist can't find the source of your pain, see a sexual pain specialist."(MARJORIE GREEN)

Marjorie Green, MD, directs the Mount Auburn Menopause and Female Sexual Medicine Center and is a clinical instructor at Harvard Medical School.

Q: Why does it hurt when I have intercourse?

A: Painful intercourse can have a wide range of physical or psychological causes, from bacterial infection to anxiety to hormonal changes due to menopause. If sex hurts, see your gynecologist and discuss the pain in as much detail as you can. Jot down basics such as:

• When the pain began
• Where you feel it (at the opening of your vagina? deep inside?)
• The nature of the pain (is it sharp? dull?)
• Whether the pain starts and stops with penetration
• If you've noticed any unusual vaginal discharge

Q: I told my physician that sex hurts and she told me that I should just try to relax. Should I get a second opinion?

A: Absolutely! Sex should not hurt. Discuss the pain with a gynecologist as soon as possible, and if he or she can't help you, ask for a referral to a doctor who specializes in sexual pain.

Q: I've been treated repeatedly for the same vaginal infection, but sex still hurts. Could there be another reason for my pain?

A: Ask your gynecologist to examine you more thoroughly to ensure that you're being treated for the right problem. For instance, what may resemble a garden-variety yeast infection could be trichomoniasis, noninfectious vaginitis, or even an allergic reaction to yeast medications, a skin condition, or a reaction to your birth control. If your gynecologist can't find the source of your pain—or insists on the original diagnosis—make an appointment with a sexual pain specialist.








 Next Page: My vagina clenches up during intercourse and it's really painful. What should I do?

[ pagebreak ] Q: My vagina clenches up during intercourse and it's really painful. What should I do?

A: You may have vaginismus, a reflexive tightening of vaginal and pelvic floor muscles. Vaginismus is thought to be the body's way of bracing itself against sexual pain. Women who suffer vaginismus shouldn't force themselves to endure intercourse; further anxiety, stress, and genital pain can cause the body to intensify its protective response. Your gynecologist can investigate the underlying cause of your muscle spasms and, if necessary, refer you to a sex therapist.

Q: My vagina itches, burns, and hurts constantly. What's going on?

A: You may have vulvodynia, a widely unrecognized chronic pain condition that affects an estimated six million American women. The cause of vulvodynia is still a mystery, but what sufferers have in common is periodic or constant burning, stinging, itching, and irritation of the vulva, clitoris, perineum, pubic area, inner thighs, and/or the outer rim of the vagina (the vestibule). Few gynecologists know about vulvodynia, so you may want to see a sex therapist, pelvic floor specialist, or neurologist. For more information, go to the National Vulvodynia Association's website,

Q: How do doctors diagnose and treat vulvodynia?

A: Before a doctor diagnoses you with this chronic pain condition, other causes need to be ruled out—such as vaginal infections, dermatologic diseases, vaginal atrophy, and fibromyalgia. Your gynecologist should ask a battery of questions about your sexual health and history, examine different areas of your vagina, and ask you to rate the pain with each touch. There's no FDA-approved treatment, but your doctor may recommend one among a range of vulvodynia solutions.

  Next Page: It hurts deep in my abdomen when I have intercourse. What could be the problem?

[ pagebreak ] Q: It hurts deep in my abdomen when I have intercourse. What could be the problem?

A: A wide range of health conditions can cause deep abdominal pain during sex. It could be a urinary tract infection, and other causes could destroy fertility if they go unchecked (such as chlamydia, gonorrhea, pelvic inflammatory disease, endometriosis). Deep abdominal pain requires immediate medical attention, especially if accompanied by fever, nausea, and vomiting.

Q: How can birth control pills affect my sex life?

A: Birth control pills can reduce your capacity for lubrication and cause vaginal atrophy, a thinning of the vaginal walls that can make sex painful. The culprits are usually the newer formulations of oral contraceptives that contain low doses of estrogen and testosterone-reducing progestin, which can also decrease your libido.

Q: How can menopause affect my sex life?

A: Dramatic hormonal changes can lead to a decline in sexual desire, an inability to become aroused, and difficulty having orgasms. Menopause can also lead to vaginal atrophy and dryness, which can both lead to pain.

Q: How can chemotherapy affect my sex life?

A: Chemotherapy—a type of treatment that uses drugs to destroy cancer cells—has been associated with changes in menstrual cycle and in ovarian reserve (the number of eggs in your ovaries), which can lead to temporary or permanent menopause symptoms and negative body image. But some women may experience none of those effects.

  Next Page: Could my blood pressure medication affect my ability to have an orgasm?

[ pagebreak ] Q: Could my blood pressure medication affect my ability to have an orgasm?

A: Yes. It can cut the blood flow to your vagina. Talk to your gynecologist about ways to maintain your ability to have an orgasm without sacrificing your cardiovascular health. This may include reducing alcohol consumption, quitting smoking, and getting regular exercise.

Q: I don't have orgasms anymore. What can I do?

A: Orgasms are a complicated mix of physical, emotional, and environmental factors. With the help of your gynecologist or sex therapist, you should examine what has changed about your emotional health, physical condition, and relationship. Keep in mind that many women don't have orgasms without clitoral stimulation. Don't be shy about experimenting with foreplay, oral sex, mutual masturbation, and sex toys.