As a gynecologist, one of the most fulfilling things I do is help women who are experiencing a variety of difficulties with intimacy. There are options available to help alleviate the problems, but proper diagnosis is needed to direct treatment.
First, I discuss with patients that intimacy is not supposed to be painful, but is meant to be enjoyable. There are many types of sexual dysfunction, ranging from decreased desire or libido to pain. When performing annual exams, I often ask patients if intimacy is painful and whether or not they are able to reach an orgasm. I have had many women look at me quizzically, saying no one has ever asked them these personal questions before. There are many illnesses, however, in which an early sign may be a decreased sensation or lack of ability to have intimate relations without pain.
Causes of pain vary, and often the age of the patient helps to narrow things down. Younger women may have extra tissue that could be resected, thereby decreasing pain. They could also have an undiagnosed infection that is causing the tissues to be irritated. Sometimes, women who have never had pain before begin to have issues after childbirth. They may have a poorly healing tear or tightness in one of the muscles in the pelvis. Endometriosis, ovarian cysts and vaginal anomalies can also be causes. Each of these has a different treatment course. An exam and sometimes tests are utilized to determine the diagnosis.
Later in life, or as I like to refer to as the “mature” years, pain with intercourse is often caused by dryness due to a decline in estrogen. This is sometimes bothersome even before women have completely stopped having periods. This pain can often be alleviated with liberal use of lubricants, and sometimes is treated with a vaginal estrogen preparation or other medications. Another cause may be lichen sclerosis, a condition in which the skin becomes very fragile, sometimes painful and itchy. Breaks in the tissues around the vagina cause discomfort, sometimes even when a woman is not having intimate contact.
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When it comes to lack of desire, there are many things to consider. Illness, medications, lack of sleep and lack of exercise are possibilities. A willingness to evaluate the relationship with one’s partner, as well as openness in communication, is also essential. We often find there tends to be pain, discomfort or decreased sensation that is impacting desire. If we can help solve the former issues, desire sometimes increases without any further intervention.
One of the greatest obstacles women face is not a lack of options for treatment as much as timidity to discuss intimate difficulties with their medical provider. A visit with a trusted medical provider may be the first step in resolving intimacy concerns.