When Sex Hurts
Probing into pelvic pain and its five most common causes.
Sex can feel amazing. But it can also feel terrible — for a variety of reasons. It can be difficult, however, for us to accept that this pain is a problem. Not only do medical professionals have a history of dismissing sexually-related pain (especially in women), but there is an overwhelming bias that sexual pleasure is a luxury. Consequently, you have a large volume of people quietly suffering.
While I may not be a doctor, I can say this: your pain is valid, and you deserve to find ways to relieve it. You are not alone in this experience. And you deserve to be heard and helped.
There is, thankfully, a growing dialogue surrounding the issue of pelvic pain, including more books addressing these issues. There are five common causes for chronic pelvic pain: Endometriosis, Interstitial Cystitis, Pelvic Floor Tension Myalgia, Pelvic Congestion Syndrome, and Vulvodynia. As stated by Dr. Richard Marvel, MD of the Center for Pelvic Pain at the Greater Baltimore Medical Center: “Most women have three or more conditions, each of which adds to their overall discomfort… If you treat just one case, the patient won’t get much better.” Proper diagnosis can be difficult, and usually involves patience, advocacy, and research on the part of the patient.
So, what are these five conditions?
- Endometriosis affects 5 million people. It occurs when cells like those in the uterus migrate elsewhere and breakdown in sync with your cycle. Symptoms of endometriosis include severe cramps, which often radiate through the lower back and leg. Treatment can involve NSAID drugs, such as ibuprophen and naproxen sodium, and hormonal birth control to shrink endometrial tissue. In more severe cases, doctors may recommend minimally invasive surgery to remove the tissue. In the most severe cases, a hysterectomy may be necessary.
- Interstitial Cystitis affects at least 3 million people. This chronic condition involves consistent discomfort of the bladder and “…may be caused by a breakdown of mucin, cells on the surface of the bladder that protect it from acidity.” It presents as a particularly severe urinary tract infection, including burning and stabbing pain with full bladders and urination— which may occur up to 60 times a day. “Elmiron, the first oral drug developed for IC, coats the bladder surface…. Doctors have also had some success with antihistamines, a variety of tricyclic antidepressants… [and] antiseizure medications.”
- Pelvic Floor Tension Myalgia is the chronic tension of the pelvic floor muscles and can occur due to a variety of issues — including trauma, mental illness, or physical trauma. Described as a heaviness in the pelvis, it is also often accompanied by burning, itching, or pain in the vaginal canal and urethra. The most effective treatments are pelvic floor physical therapy. In addition, some patients may try botox injections to relax the muscles, or targeted injections of lidocaine to relieve pain.
- Pelvic Congestion Syndrome is suffered by 7 million people and is caused by vericose veins form in the pelvis. Describe as a dull, aching pain in the pelvis, it is absent/mild in the morning, gets gradually worse through the day, and is only improved by lying down or applying heat. The first course of treatment involves progestin, which has been shown to shrink the vericose veins. If that doesn’t work, embolization provides relief in 70% of patients. The last course of action is a hysterectomy.
- Vulvodynia impacts 6 million women. Simply put, vulvodynia is chronic pain, and is an umbrella term for a variety of conditions. About 75% of people who suffer from vulvodynia have vulvar vestibulitis, or pain at the opening of the vaginal canal. A persistent stinging or burning sensation in the vulva, it can be triggered by inserting a tampon, sitting, or wearing tight fitting pants. Approximately 80% of vulvodynia sufferers experience pain during vaginal penetrative intercourse. “First remedies for vulvodynia include antiseizure drugs, antidepressants, and the topical anesthetic lidocaine. Some specialists have had success by compounding all of these drugs into a topical formula that’s applied directly to affected tissues…. Surgery to remove nerve endings at the entrance to the vagina (the vestibule) helps up to 90% of women with vulvar vestibulitis, but it’s a last resort.”
If you do feel like you are suffering from one of these issues there are resources available, including online support networks, books, and a variety of products. Please check out my accompanying blog post for links to some of these products and books recommended by other sex educators and specialists!
Have questions about sex? Download Tabú in the app store today!
