Pain during sex. One study reported that 40 per cent of women suffer from it.Another found it affected around 10 per cent of women. Determining the true number is difficult, as many are too embarrassed
Angela without doubt loved her husband of 44 years – however there was something missing in their marriage: a sex life.
When her hubby eventually turned to her after years of this and lamented: ‘I want my wife back,’ Angela knew its time for her to seek help.
‘That was the moment I knew I couldn’t avoid the problem any longer,’ recalls Angela, 66, a retired teacher and mother of two.
Angela is suffering from dyspareunia – pain during sexual intercourse. She had the problem for six years from the age of 57, before eventually plucking up the courage to find help.
It’s incredibly a very common problem. One research published in the journal Menopause in 2008, using the results of an private questionnaire, revealed that 40 per cent of ladies suffer from it.
Yet another study, published, in the Scandinavian Journal of Public Health, discovered it afflicted around 10 per cent of women. Finding out the true number who go through pain during sexual intercourse is actually difficult, as many are simply just too shy to look for help.
‘The crucial thing to remember here is that there is lots that can be done to pinpoint what is causing the problem,’ says Dr Sarah Jarvis, a London-based General practitioner. ‘But women need to start off by going to see their Doctor, and that can be hard to do if you are feeling embarrassed about the whole issue.’
She states she has seen relationships break up due to painful sex – yet usually the cause can easily be identified.
‘I can take swabs, check for infections or inflammation, investigate if their contraceptive coil has slipped out of place, or do ultrasounds and ultimately refer on to the appropriate specialist if I think it necessary.’There is a number of causes. ‘Illness or infection, physical or psychological, or a combination of several factors can trigger it,’ says Kate, a pelvic-floor physiotherapist at the Western Infirmary in Glasgow.
Probably the most well-known causes is menopausal changes. Falling amounts of the female hormone oestrogen, which usually keeps tissues moist and healthy, may cause vaginal dryness.
‘Also, post-menopause, the vagina is not as elastic and expandable as it was,’ adds Kate . This is because the drop in oestrogen affects collagen, the protein that helps keep tissues healthy. The physical problems can be compounded by the effect that falling hormones have on sex drive, mood and energy.
The physical discomfort is often helped with hormone replacement therapy (HRT), oestrogen cream or pessary. The benefit of the cream or pessary is that it works just where it’s needed, increasing blood flow, improving lubrication and boosting tissues, and has less risk of side-effects.
Gel or cream may be used two times a week and is left in overnight. An alternative choice is a vaginal moisturiser. They are much better than KY Jelly, explains Dr Heather Currie, a consultant gynaecologist.
The reason being KY Jelly is a short-acting product developed for medical use, while vaginal moisturisers stay longer and are more appropriate, she says, for sexual activity.
Yet while all these treatments could make a difference, Ms Lough says many older women feel almost ashamed of their issues.
‘Some women feel embarrassed about being sexually active into their 70s and don’t ask for help if there’s a problem,’ she explains.
A number of women feel embarrassed about being active sexually into their 70s and don’t ask for assistance when there’s a problem
It was actually the case for Angela. But after finally plucking up the bravery and courage to go to her doctor, she was given pessaries and oestrogen cream, which happen to have resulted in a great improvement. She was amazed there can be ‘such a simple solution’.
There are lots of other causes of painful sex, nevertheless. Some women can experience problems because of scar tissue from a tear in the perineum made in childbirth from an episiotomy (where an incision is made in the perineum to help deliver a baby).
Approximately 90 per cent of women have a tear during their first delivery. Often any discomfort or pain might not become obvious until years later, for example when the woman passes through the menopause and hormonal changes start to affect the tissues in the area.
Issues with scar tissue usually can be taken care of by a small procedure – known as Fenton’s procedure – where the scar tissue is removed. This can be done as a day case, often under local anaesthetic, and the woman recovers almost immediately, explains Pat O’Brien, a consultant gynaecologist at University College London Hospitals and a spokesperson for the Royal College of Obstetricians and Gynaecologists.
Another cause of pain during sexual intercourse is endometriosis, when womb-like tissue grows in the ovaries, fallopian tubes or cervix. Patches of endometriosis can vary in size from a pinhead to large clumps.
Women with this condition may feel pain deep inside, which may last a few hours after sex. The pain, which is in the lower tummy and pelvic area, can be constant, not just around the time of intercourse, and may be particularly intense on the days just before and during a period.
Fibroids – growths of muscle and tissue in the womb – can also cause problems. While fibroids themselves are not painful, they can make the womb quite ‘bulky’, which in turn can lead to discomfort during intercourse.
Constipation or a bout of irritable bowel syndrome (IBS) can also have an effect.
More everyday triggers include general irritation or allergy caused by soaps and shampoo.
Mr O’Brien advises against using intimate feminine hygiene products. ‘The vagina needs a certain amount of good bacteria to be able to do its job properly. There is no need to buy special products – a sensible personal hygiene routine is all that is needed.’ For June Edwards, 57, a retired administrator, the solution was not straightforward. She was diagnosed with lichen sclerosus, a skin disorder that causes small, itchy or sore white spots on the genitals.
With time, these spots may become larger and come together to create large, white plaques. They can make sex feel painful
Very common in women over 50, its cause is not known, although not contagious. One in 1,000 women is affected, but it’s believed milder cases go untreated as women don’t seek help or believe it to be thrush.
But unlike thrush, lichen sclerosus doesn’t cause discharge, and over-the-counter medication for thrush won’t help it.
June suffered with lichen sclerosis for eight years from the age of 49, during which time it got worse. She waited seven years until she went to her GP. There, she was referred on to a gynaecologist, who prescribed steroid cream to reduce inflammation.
She was also referred to Kate Lough for help tackling the pain.
Some causes may be more psychological than physical – vaginismus, a condition where muscles at the vaginal entrance shut tightly, can make sex painful or impossible.
Kate says: ‘The reasons for this condition can be physical or psychological – there may be a background history of abuse, or trauma from childbirth.
‘A vicious cycle may be set up, with pain leading to nervousness about intercourse, which in turn leads to further tension and pain.’
Dr David urges anyone who experiences pain with sex to seek help, as in almost every case ‘things can be done to improve the situation’.
names have been changed