What is causing me pain during intercourse?
Endometriosis: This is a condition where you can have pain with bowel movements, painful periods, but they can also have pain with intercourse. One of the first things I think about when a patient comes in complaining of pain during intercourse is endometriosis. The reason for that is because right at the top of the vagina is the most frequent place where little endometriosis implants are going to start to grow. Those implants have the ability, when they are irritated, to release prostaglandin which can cause bloating, cramping, nausea, vomiting, and pain. The only way we can really diagnose whether or not there is endometriosis present is by performing laparoscopy where we take a look inside and see whats going on. During surgery, we can remove the growths. When they are removed, the tissues heal, and there is no more pain with intercourse.
Interstitial Cystitis: The floor of the bladder is estrogen dependant and its the only part of your bladder that has sensory nerves and can cause the sensation of pain. This part of the bladder is also located right at the top of the vagina which means that when you're having intercourse, this area is frequently under pressure. So if this area is thin and irritated, the nerves are sending a signal to your brain that you are in pain.
Low Estrogen: The floor of the bladder and the entire vagina are estrogen dependent. If you don't have enough estrogen several things are going to happen: the pH in your vagina will become more alkaline causing an increase of yeast and other bacteria, and no matter how much foreplay you have your body won't be able to lubricate itself. Prior Surgery: If you've had any type of vaginal surgery, there is always the chance for scar tissue. Scar tissue is never as flexible as is your natural tissue and may become irritated during intercourse. An increase in your estrogen can help better lubricate your vagina during intercourse and limit the amount of pain you experience.
Assault: "Ladies that have been assaulted have been through an extremely traumatic experience. Sometimes having intercourse or even a routine pelvic exam can stimulate memories of that event. They may or may not have been all the way through the grieving process which can also cause them to hold onto negative associations. Ladies that have been in this situation take a long period of time to get back to having "normal" intercourse.
We go through a desensitization process. We'll do an exam and assure the patient that physically everything is normal. We then discuss different approaches to desensitization. It is very important that you have times in which you an intimate without any penetration. Over the course of several months you can slowly move from no penetration, to penetration with fingers only, to sexual intercourse. Once you've gone through the desensitization process, you can have sexual intercourse without pain. You have to have a partner that is willing to move through this process with you at your pace.
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