What you may have been labeling as “lack of sexual interest” or “painful sex” is a form of sexual dysfunction, a common and frequently treatable issue. The term “sexual dysfunction” refers to a recurring or persistent problem that interferes with a person’s ability to have sex or enjoy a sexual experience. Sexual dysfunction can occur at any point in a woman’s life. The process of sexual enjoyment is complex, especially in women. There are multiple points at which the “dysfunction” can occur, and many times there is more than one factor at play.
Common problems which can occur include:
- Low desire or the lack of sexual interest
- Lack of arousal or difficulty maintaining the arousal
- Inability to achieve orgasm
- Pain instigated by intercourse or chronic pain preventing intercourse
Low desire, lack of arousal and inability to achieve an orgasm can be due to:
- Medications, such as anti-depressants, high blood pressure medication, alcohol, and illicit drugs.
- Mental state as it relates to the relationship with your partner, cultural or religious issues as it pertains to the act of sex, and issues with body image.
- Stress and anxiety—This can be situational as well as chronic
- Hormonal changes, such as menopause or changes in contraception.
- Medical problems, especially those that affect the nerves and blood vessels (i.e., diabetes, peripheral vascular disease).
- History of sexual abuse and post-traumatic stress disorder, or a negative sexual experience.
Menopause
Menopause is the point in life where the body no longer produces estrogen. Natural menopause is defined as no menses for one year. You may be at the point where menses may be present but irregular, which is referred to as peri-menopause. Sexual function can change both with peri-menopause and menopause, as well as with surgical menopause (when the ovaries are removed surgically). This is due to the lack of estrogen in the vagina which makes the vagina drier, less elastic or flexible, and decreases the blood flow to the area causing the vaginal skin to become thinner.
Pain
Vaginal pain can be caused by other reasons beyond hormonal changes, especially in women who are premenopausal. Pain disorders can cause sexual dysfunction cycles which can be a challenge to break. One can experience pain with intercourse, vaginal dryness, constant vaginal/pelvic/lower abdominal pain, and vaginal irritation which may be mistaken for vaginal infections or urinary tract infections. However, the negative experience associated with a painful sexual experience can trigger an ongoing sexual dysfunction cycle.
Steps to Addressing Pain with Intercourse
The first step is to identify what is prompting the pain (there may be more than one contributing reason), then to focus therapies (more than one therapy simultaneously is often necessary):
- An anatomic issue with the vagina—Sometimes if a woman is dealing with a scar tissue band or pelvic organ prolapse/vaginal bulge this may change the anatomy (the shape) of the vagina. This change in structure may result in painful intercourse. Addressing these anatomical changes may require pelvic floor physical therapy or surgery to correct the issue.
- Pelvic floor dysfunction—If you have experienced pain with intercourse or even without intercourse, the cause may be abnormally tight pelvic muscles. This inability to relax pelvic floor muscles may cause abnormal feedback to pelvic organs causing pain, bladder dysfunction or anorectal dysfunction. Pelvic floor physical therapy is the most commonly prescribed treatment, but other therapies may be necessary in conjunction with physical therapy to achieve better sexual function and alleviate pain.
- Vulvovaginal skin changes— The thinning of the walls of the vagina caused by decreased estrogen levels is a change in the vagina that occurs with menopause, and sometimes during the peri-menopausal period. There are hormonal and non-hormonal therapies which can be initiated for treatment. Other times, hormonal changes may not be the issue. Lichen sclerosus is an autoimmune skin condition of the vulva (outside of the vagina) which can cause irritation and pain. The treatment for lichen sclerosus is different and will need a biopsy first to confirm the diagnosis.
- Interstitial cystitis (IC) or Bladder Pain Syndrome—This is a condition of the bladder which can cause bladder pain, urinary urgency and frequency, and painful intercourse. IC often makes one think she has urinary tract infections but will have negative urine cultures. There are many ways to try to alleviate IC which include diet changes, pelvic floor physical therapy, stress management, or medications.
- Stress and anxiety, history of sexual abuse—Finding outlets or methods to manage stress and anxiety are paramount to break the pain cycle. Psychotherapy is very important with pain and anxiety disorders, as well as, with a history of sexual abuse to obtain better overall function and strengthen relationships thus helping sexual function.
- Other medical issues may cause pelvic pain and pain with intercourse such as endometriosis and irritable bowel syndrome. Other specialists may need to be involved in helping manage these issues.
Multidisciplinary approaches with pelvic floor physical therapists, psychiatrists/counselors, gynecologist or urogynecologist, and other specialists such as urologists and gastroenterologists are often required for managing pain disorders or painful disorders.
Talking to your primary care physician or gynecologist openly about your sexual dysfunction, and how it is impacting your life and relationships is a necessary first step. Your physician may be able to help you or may refer you to a specialist. Therapy will take time, especially since there is no “magic cure” for sexual dysfunction. However, with positive steps in the right direction, sexual function can be improved.
Call 404-778-3401 to make an appointment or visit emoryhealthcare.org/gyn to learn more.
About Sana Ansari, MD
Sana Ansari, MD is a Urogynecologist and Pelvic Reconstructive Surgeon with Emory Women’s Center, and Assistant Professor at Emory University School of Medicine. Her specialties include Female Pelvic Medicine & Reconstructive Surgery, Urogynecology, and Obstetrics and Gynecology. She is currently accepting patients at Emory Johns Creek Hospital and Emory Saint Joseph’s Hospital.
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