Unwanted pain during sex (whether that means self-pleasure or partnered) sucks, I know. It can affect your sexual desire and satisfaction, self-confidence, relationships, and overall quality of life. According to the American College of Obstetricians and Gynecologists, as many as 75% of people with vaginas experience pain during sex at some point in their lives. The reality is that this pain can show up during gynecological assessments, when inserting a tampon or menstrual cup etc. None of these should be painful and it’s time to figure out ways you can break this cycle.
While vaginismus is not always the cause of the pain, this cycle is something that can be relevant to many people who experience vaginal pain and pain with sex.
1. Rule out any medical conditions
When vaginal pain is expressed to your doctor, there are some key conditions that they will aim to rule out. This can include things like cysts, pelvic inflammatory disease, STIs, vaginal atrophy, endometriosis, fibroids, and cystitis. A medical evaluation usually consists of:
- A thorough medical history. This can include questions about diagnoses, medications, surgeries, family medical history, menstrual history, and sexual history.
- A pelvic exam. This is where your doctor can visually assess the vulva (clitoris, labia majora + minora), vaginal opening, vaginal canal, and cervix for any signs of irritation, infection, or other abnormalities. An internal and external physical exam can also be used to assess your vulva, vagina, uterus, and ovaries, as well as the pelvic floor muscles in the area. This is helpful when assessing for any structural abnormalities or infections that may be causing the pain.
- Further testing. The doctor may need to run some lab tests to assess for infections, hormonal imbalances, and other conditions. If indicated, a pelvic ultrasound (which may include a transvaginal ultrasound), may also be requested to assess the vagina, uterus, and ovaries more fully.
2.Treat the root cause
Treatment must be dependent on the actual cause or causes of the pain. From the medical evaluation, there might be indicated treatments from both a naturopathic and conventional perspective that can help get rid of infections, improve lubrication, regulate hormones, etc. If there is a mental or emotional component, counselling, mindfulness-based therapies, and appropriate herbs, supplements or medications may be used. A history of trauma is also something that must be a priority and treated with the utmost care.
3.Get the support you need.
Making sure you feel supported throughout this is HUGE. This might mean talking to your partner or partners about what you’ve been experiencing. Open communication about this can be fundamental to building trust, connection, and honesty within your relationships. Reaching out to counsellors and sex therapists can be extremely helpful, especially when we consider the massive role our mental and emotional health play in sexual wellness and satisfaction. Talking to friends or family about it can also open your eyes to how common this is and allow you to feel less alone on your journey.
4.Build + diversify your health care squad
Some health professionals to explore and consider:
- Medical doctor and/or gynecologist
- Naturopathic doctor
- Pelvic physiotherapist
- Counsellor and/or sex therapist
- Acupuncturist
As a sexual health advocate, it is time to start normalizing these conversations with healthcare providers. It’s crucial that you build a team who you trust, who respects you and puts your needs first. This might mean consulting with them beforehand to ensure it’s a good fit or firing one of them and finding someone new. Your body, your health, your choice. PERIOD.
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Header photo by Oleg Ivanov on Unsplash