Sex shouldn't hurt! If you're the one suffering from pain with sex or your partner's having a
hard time with sex because of pain, it can put a real damper on your sex life. And what's even
worse is so many of these people go from doctor to doctor without an explanation of why they're
having pain or a treatment that works. I'm Dr. Rena Malik, urologist and pelvic surgeon, and
today I'm gonna go over the most common causes of pain with sex for women. If you are a man please
be sure to share this with your partner or any female you might know that is having difficulty
having pain with sex, and if you want to learn about causes of pain with ejaculation or orgasm
for men please comment below and I'll make a video on that as well. The number one cause for
pain with sex for women under 50 is vulvodynia. What exactly is vulvodynia? Well it's pain that
occurs with any sort of light touch to the vulva the vulva is the outside of the vaginal canal not
the lips of the vagina but inside that I didn't include a picture because youtube will probably
make this video unvisible to so many people if I do so what are the different causes of vulvodynia
well there are many they can include problems with your nerves they can include problems with your
muscles or your hormones or your genetics and so there's lots of different causes of this problem
but fortunately there are treatments available so the first thing is kind of conservative management
which all women can do these are things that will help you feel more comfortable so one is using
cotton underwear because other fabrics can be irritating to the vulva also avoiding over washing
so yes you want to wash it with lukewarm water you can let soapy water run down but you don't want
to do aggressive hygiene because that can cause dermatitis or dermatologic conditions to the vulva
and irritation you also want to avoid very scented detergents or soaps because those
can irritate the area as well lastly you want to make sure that you remove your bathing suit
if you after you go swimming right away sitting in a wet bathing suit for a long period of time
can cause a lot of irritation whether it's just regular old water or even chlorinated water so
other treatments for vulvodynia can include pelvic floor physical therapy or hormonal creams like
estrogen and testosterone these have actually been shown to decrease the sensitivity of the vulva to
stimuli that are painful there are also other types of things like injections botox or other
anti-inflammatory agents that can help with this pain as well as medications you can also
try using a lidocaine cream or any other cream like emla that has lidocaine and prilocaine in
it these work to numb the vulva and while it's not a treatment it's more of a band-aid it can
really make a big difference you can also look for delay sprays that are used typically for men
those have the same ingredients like lidocaine and prilocaine in them that can help with some of that
discomfort the next most common cause of pain with sex in women over 50 is called the genitor urinary
syndrome of menopause and this affects over 50 percent of women who are undergoing menopause and
surprisingly menopause symptoms or perimenopause symptoms can start as early as age 46.
so what exactly is the genetic urinary syndrome of menopause well as you go through menopause
your hormone production including your estrogen production and your testosterone production
decrease and what happens well when your estrogen production decreases the ph of
your vagina actually increases and this causes a host of problems it can cause thinning of the
epithelium of the vagina which results in vaginal dryness and this in and of itself can cause pain
with sex if you have dry tissue down there it's going to cause some discomfort also because the
ph of the vagina increases it actually causes you to be at higher risk for bladder infections or
urinary tract infections because having a low ph is actually protective against bacteria that cause
urinary tract infections so other symptoms of the genital urinary syndrome of menopause can include
of course vaginal dryness it can cause burning or itching and occasionally some discharge or
bleeding and then on top of it as I mentioned you can have urinary tract infections more often when
you're suffering from this problem and sometimes you might just have symptoms like urinary urgency
or frequency meaning you're going to the bathroom more often or more urgently and you can't wait to
get to the bathroom what is the treatment for this well the most common treatment is using
a estrogen treatment in the vagina this can be a cream a suppository or a ring and it's a very low
dose of estrogen so the side effects are extremely minimal it's very different from the estrogen that
you're prescribed to take orally the systemic absorption is extremely low which means that
you don't get the concerns of breast tenderness blood clots breast cancer any of those things
in fact I've linked some papers down below that show that there is really no risk of breast
cancer or blood clots with the use of vaginal estrogen so really everyone who wants to be on
it because of their symptoms should be on it okay another problem that occurs that causes pain is
inadequate lubrication it seems simple right but there's a lot of different causes of inadequate
lubrication it's not that the person that you're with is not exciting you you may have some anxiety
or fear about having intercourse you may not have had adequate amount of foreplay or you may
have some history of sexual abuse or trauma that affects the ability to have normal lubrication and
lubricants are really readily available very cheap and come in a number of different formulations
and I'm actually going to release a video on lubricants very soon going over a whole bunch of
different lubricants and if there's something that you want me to look at comment below and I'll look
at that as well but it's super easy you can use water-based lubricants silicone-based lubricants
or even go in your kitchen and look for coconut oil or olive oil and just use that and it works
great and it can help with pain for a lot of people in fact there's a lot of different things
that can cause inadequate lubrication these can include hormonal problems or taking oral birth
control pills that have estrogen progestin in them that can actually cause some vaginal
dryness and pain with sex also diabetes other neurologic disorders having previous history of
chemotherapy or radiation or several medications like antihistamines anticholinergics that you
might take for bladder symptoms those can also cause vaginal dryness I will list a whole bunch
of medications or things that can cause dryness and you just pause here and take a screenshot
the next most common thing that I see in my clinic is pelvic floor dysfunction or hypertonic pelvic
floor muscles I've described this before in another video and I'll link that up here but
essentially what it is is that your pelvic floor muscles are super super tight and there's a number
of different causes for it it can be because of having a lot of stress or anxiety it can be due
to musculoskeletal problems like the way your body is aligned or even positional issues so if you are
positioned for a long time of sitting in fact I've seen a lot more pelvic floor dysfunction
with covid because people are at home sitting at their desks a lot more often and so that can
cause high tone in your pelvic floor muscles and usually there are triggers so you won't
always have discomfort but you might notice that if you have done a lot of sports activities it can
make it worse or if you recently had a baby had a pregnancy or a delivery that can make things worse
as well the treatment for this is primarily pelvic floor physical therapy and what you do when you go
to pelvic floor physical therapy is you actually learn how to relax these muscles and identify
areas that are maybe trigger points and how you can actually assess these trigger points and relax
them so you can have less pain I've actually linked below a physical therapy locator that
can help you find a physical therapist near you another cause of pelvic pain or pain with sex
is pudendal neuralgia and the pudendal nerve is a nerve that supplies a bunch of areas in
the pelvic floor and this can include the vagina the clitoris the perineum and the buttocks and
all these areas can suffer if you have pedental neuralgia now what exactly is that well that's
kind of an inflammation of this nerve called the pudendal nerve and it can be caused primarily by
entrapment or inflammation of that nerve from things like prolonged sitting cycling horseback
riding or prior surgeries and this particular pain can be very uncomfortable it can feel like
a burning prickling shooting sensation it's often worse when sitting down and it can kind of wax
and wane so you might have more pain some days and less other days you might also notice that you're
having a little bit of increased sensitivity to pain and that's where something as simple
as putting on clothes can cause discomfort and we think some of that occurs because of a
central sensitization so when you have chronic pain your whole body can perceive normal stimuli
as painful and that's because our brain chemistry changes and it actually intercepts these normal
things like rubbing your arm as painful treatments for this can include pelvic floor physical therapy
anti-inflammatory or neuropathic pain medications like gabapentin or lyrica or pudendal nerve blocks
so blocking the actual nerve to see if your pain gets better another cause that is rarely discussed
is called clitoral adhesions so the clitoris has a hood around it and around that hood you
can actually get adhesions that stick that skin above the clitoris making it hard to retract
and so when you have those adhesions they can become painful and cause pain in your
clitoris and you can feel that as pain with intercourse or pain that's there all the time
also if you've suffered any sort of female genital mutilation this can result in different sorts of
pelvic pain depending on exactly what occurred there are so so many other causes but common ones
are infections of different kinds urinary tract infections or sexually transmitted infections
dermatologic conditions where there might be skin changes that are causing pain
if you are postpartum it's actually very very common when you look at the data up to 12 months
after having a baby somewhere between 7 and 30 of women experience pelvic pain or pain with sex
if you have what's called a urethral diverticulum this is a structural abnormality underneath the
urethra that can cause pain with sex dribbling and recurrent bladder infections or having pelvic
surgery in the past or having mesh placed in the vagina in the past and having complications from
that can cause pain as well and lastly there are a number of gynecologic abnormalities including
endometriosis fibroids ovarian pathologies that have been linked to pelvic pain and so definitely
see your gynecologist to make sure you're not suffering from any of those this was just a
overview of all the causes of pain and really a public service announcement to you if you are
suffering or your partner is suffering seek help there is help out there you don't have to suffer
and you deserve a good sex life as always remember to take care of yourself because you're worth it