PAIN DURING SEX: Q&A

Q: I now have “pain down there” for no apparent reason. The first time I had sex it was slightly painful but the pain faded away and felt good.  On a few other occasions following that time, the same thing would occur: a little bit of pain but then fading away. But lately if we switch positions or he falls out he cannot insert again. If he does it’s excruciating pain for me. He can’t put it in again, it feels “too tight”. I experience burning pain during sex and afterwards it hurts to urinate (only right after we have sex though). I’d go to a doctor but I have no insurance so I’m unable to afford it. What’s going on?

A: First of all, let us assure you that you are not alone in experiencing these symptoms. There are countless individuals going through very similar situations right now, many of whom also are not getting helpful answers from the medical community. We often see "UTIs" and "yeast infections" overly diagnosed in cases like yours.  Of course you need to rule these out. But this can easily be done by going to a nurse practitioner at a Planned Parenthood clinic (fees are usually reasonable even without insurance). If the tests are negative or the treatments don’t help you, don’t continue to accept antibiotics or creams that aren’t proving to be affective in treating your pain. Please also consider:

1. Be sure to always use a good vaginal lubricant, such as Astroglide Gel (not the liquid), another product actually named "Slippery Stuff" which you can find on-line, or even simple coconut oil.   These products are generally tolerated by most women even if they have minor inflammation at the vaginal opening (Vestibule).  Make sure to put these lubricants on yourself and your partner to eliminate any friction which can help to minimize the pain 

2. You could also be experiencing muscular restriction at the vaginal opening (Pelvic Floor Dysfunction - a clenching response to increased sensitivity to touch or friction at the Vestibule). With initial penetration - these muscles (pubovaginalis) are stretched, which may be creating your initial burning pain which then subsides as sex continues.  Any time re-entry needs to happen (switching positions or him falling out), your brain perceives this as a "dangerous" situation and your pubovaginalis "clenches"  to protect the area of pain.  There are certainly exercises that can be done to help to 1) stretch the vaginal opening and 2) retrain the brain that your vaginal opening is not a "danger zone" so that the red flags gradually fade and your gripping reflex is no longer present allowing your partner to enter with low to no pain.  

3.  Since you say you have "excruciating pain" with penetration, the simple suggestions above may not be helpful enough.  If you have already tried these simpler solutions and they are not helpful and you continue with pain, you may have the early signs of vulvar vestibulitis as well as interstitial cystitis / painful bladder syndrome (IC) contributing to penetration pain.  Early signs of both of these conditions are quite common in young women.  (Usually deeper penetration pain is associated with IC as the tip of the penis "hits" the irritated bladder.  Initial penetration pain can be associated with vulvar vestibulitis as the sensitive tissue of the irritated vestibule are stretched) Consider drinking more water and de-acidifying the body by lowering acids in the diet to lower the inflammation that can occur in the bladder, urethra and vestibule. To download our Vaginal Health Guide click here. 

4.  Our DVD Healing the Pain 'Down There’ can help educate you on why this all might be happening and will give you strategies to help make it better yourself and also to help find professionals who may know more about these issues. 

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