It’s Valentine’s Day. You all know what that means…
[Cuts to video of the group Salt-N-Pepa singing their song “Let’s Talk About Sex”]
For real, though, let’s talk about sex — and something that people don’t talk about: painful sex, why it happens, and could that be related to endometriosis?
Hi, I’m Doctor Rich, and my passion is to provide every woman with practical knowledge about the world of women’s health. Let’s get our sex talk on!
Don’t have time to read this post? Watch the video here instead!
Why is sex painful?
Well, there are a lot of reasons — and it varies from endometriosis, to irritable bowel syndrome, to relationship problems. It’s a complex interplay of different factors, and we’re going to break down what many of them are. We’ll also talk about how endometriosis can cause sexual pain.
So pain with sex. The medical term is dyspareunia — or more broadly, female sexual pain.
This is broken down into four different categories, which include pain with sexual penetration, genital pain with genital touching, fear or anxiety that arises with the thought of sexual touching or stimulation, and lastly, hypertenicity of the pelvic floor (or basically muscle spasms that occur during sex).
The identified cause behind these different pain syndromes might be a problem with the anatomy itself that could be related to trauma (from childbirth or from surgery or some other sexual trauma). It could also be infectious, it could be cancer, or it could be hormonal balances. It could be an inflammation or a neurologic disorder, it could be psychological — or it could just be an issue with the relationship.
We spend a lot of time considering the different anatomic female reproductive structures, like the vulvar tissue, the vulvar skin, the vagina, the cervix, and the uterus. But there are other organ systems that can also contribute (or be the cause of) sexual pain, like the bowel, the bladder, the nerves, the pelvic floor muscles — and disorders of these conditions can also result in female sexual pain.
There are also dermatologic (or skin diseases) that can be related. There are also cultural issues or certain medications (even over-the-counter medications) can make these conditions worse!
So some of the most common disease processes that result in sexual pain that we see every day include:
- chronic pelvic pain
- a history of sexual abuse
- problems with the relationship
- bowel disease (such as irritable bowel syndrome or Crohn’s disease or diverticulitis)
- and from the urinary system, a condition called interstitial cystitis (or just regular cystitis or bladder infections)
- recurrent vaginal infections (yeast infections) can also cause sexual pain
So with all these things, there has to be a willingness on the part of the physician to ask these kinds of questions — because a lot of times patients don’t feel comfortable. They feel they’ll be patronized if they bring these things up. And there also needs to be a willingness on the part of the patient to have an open mind that there could be other factors — that maybe they don’t want to consider — that are related to the sexual pain.
And another thing to keep in mind is it’s rarely ever one thing — so it requires a very exhaustive, extensive, focused physical exam and history. And once we have all that information, we’ll be able to figure out and pinpoint the cause — and take care of that one layer at a time.
One of the common causes for sexual pain that we see is endometriosis. If you don’t know what endometriosis is, you can check out this video here.