Not Tonight Dear, I Have a Vagina-Ache

Am I Weird?

Women are supposed to like sex, right? I mean, all girls dream of the perfect mate that will woo her and wed her, and bed her. We dream of candlelight dinners on the beach, and long walks hand-in-hand. We long to feel so special to someone, and so comfortable, that you want to be intimate with them in every way. So, why do some of us not feel like that? Why do we avoid sex?

Ladies, you are not alone! Low libido is something we gals just don’t talk about. We avoid the topic like herpes. No one wants to admit that things in the bedroom aren’t perfect. But the survey stats show that about 27% of premenopausal women, and up to 52% of postmenopausal women complain of low libido. One of the more common reasons for this might surprise you, or it might make total sense. Let’s chat about it.

The First Question.

If you are having issues with low libido, the first thing your doctor is likely to ask is “Does sex hurt?” If you think about it, this is a good place to start. Pain is a natural deterrent. Who wants to keep putting their hand on a hot stove after they’ve burned themselves? We avoid stubbing toes, getting hit in the face, and wearing shoes that give us blisters. Obvious, right? But people don’t always consider that sex might be the same way.

Why Pain with Sex Causes Low Libido.

This phenomenon of avoiding pain is called fear conditioning. When your brain links something to pain, subconsciously (or consciously), you avoid it. In studies, scientists have been able to show how this works. When you are put in a situation and then pain is introduced, you learn to avoid the situation altogether, not just what caused the pain.

There have been studies about lab rats who avoided everything from food to a particular location due to being zapped on the foot when exposed. Funny enough, they’ve even studied mating behavior in rats when given shocks. The females avoid being mounted. Oddly, the males aren’t deterred. Let’s leave trying to explain that one for another time.

The areas of the brain that react to pain conditioning are the ones that control moods and create memories. So when you put together a certain mood (feeling sexy), with a certain memory (two days of burning vaginal pain), your mind stores that. The next time you’re in that same mood, or a similar one, your brain recognizes it, remembers how it made you feel last time, and sends out a danger signal. It literally thinks you’re about to put your hand on a hot stove.

If you’ve experienced pain within the context of sex, your brain remembers it. This learned fear can cause you to avoid just the act of sex, or it might lead to complete avoidance of anything that might go there. Some women even start getting irritated when sent flowers, because they know what’s coming. Seeing an erect penis or a personal massage device would certainly set off a red flag.

I’m Worried About my Marriage…

Obviously, when you get annoyed with a kiss on the neck, your partner notices. Avoidance of intimacy can really rock a marriage. The good news is, when your libido issue is caused by pain, it’s often treatable. Now, don’t get me wrong; the fix doesn’t happen in a few days. You and your partner will need to be invested in treatment. If you both get involved, the outcomes are much better.

What’s the Treatment?

The first step is to find out what was causing the pain. Did you have a yeast infection? Does your uterus tip backwards? Is the skin at the entrance to your vagina particularly sensitive? Maybe you have bladder pain or endometriosis. These are all medical issues that your Gyn or a pelvic pain specialist can diagnose. Once we know what caused the pain in the beginning, we can treat it. Sometimes it’s as easy as trying different sexual positions. Most of the time, it’s a combo of medications, counseling, and possibly surgery. The course of treatment may be for the long haul.

After the original source of pain is better, you’re not exactly in the clear. Remember the fear conditioning thing? Your brain is still linking sex with pain, even after the pain is gone. Therefore, we still need to work on this part. Retraining your brain to think that sex is awesome again takes some time. Typically, I recommend cognitive behavioral therapy and vaginal dilators. The dilators are not to stretch your vagina, as some might expect. They’re actually to teach the brain that having something inside your vagina isn’t painful anymore. Dilator therapy often takes several months. Most women eventually get to a point where they’ve convinced their brain that a moderately sized dilator doesn’t hurt anymore. Now we’ve got to convince your brain that the actual penis/toy doesn’t hurt either. This typically involves lots of foreplay, and a sort of bait and switch technique.

Will My Libido Come Back?

“Doctor, I had sex and it didn’t hurt. But I didn’t enjoy it either. What’s wrong with me?” I’ve heard this a few times. Once you’re able to have pain-free sex again, we’ve removed the fear of sex. That doesn’t mean we’ve reintroduced the fun yet. Most women find that it takes a while of having pain-free intercourse to get back to their frisky selves. Your mind is thinking, “We’ve done this once or twice, but I’m not convinced.” It takes several weeks, sometimes even months for sex to be fun again. Often this is where the counseling comes in. Try adding in fun foreplay. Dress up. Do clitoral stimulation first. It’ll get there. While you’re working on getting your mojo back, it’s important to keep having sex. It’s good for your partner, and the best way to increase your libido. Pain-free sex eventually leads to fun sex for almost everyone.

What Should I Do?

The first and most important thing is to remind yourself that you’re not alone.  Look for facebook groups for women having pain with sex. They’re out there. And if you ask your friends if any of them are having issues with painful intercourse, I bet you’ll find some of your besties are in the same situation!

The next best step is to find a Gyn or Pelvic Pain Specialist that can figure out why you are having pain. Don’t be shy; your Gyno needs to know this stuff, and is trained to talk about your sex life, even if it feels weird to you. Low libido due to pain with sex is often very treatable. We can get you back to liking sex, maybe even initiating. Yep, it’s possible!

References:

West SL1, D’Aloisio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med. 2008 Jul 14;168(13):1441-9. doi: 10.1001/archinte.168.13.1441. PMID: 18625925.

Melissa A. Farmer,1,2 Alison Leja,1 Emily Foxen-Craft,1 Lindsey Chan,1 Leigh C. MacIntyre,1 Tina Niaki,1 Mengsha Chen,1 Josiane C.S. Mapplebeck,1 Vanessa Tabry,1 Lucas Topham,1 Melissa Sukosd,1 Yitzchak M. Binik,1,2 James G. Pfaus,3 and Jeffrey S. Pain Reduces Sexual Motivation in Female But Not Male Mice. J Neurosci. 2014 Apr 23; 34(17): 5747–5753.doi: 10.1523/JNEUROSCI.5337-13.2014 PMID: 24760835.

Victoria L. Handa, MD,* Geoffrey Cundiff, MD,† Howard H. Chang, B.Sc,‡ and Kathy J. Helzlsouer, MD, MHS§. Female sexual function and pelvic floor disorders. Obstet Gynecol. 2008 May; 111(5): 1045–1052. doi: 10.1097/AOG.0b013e31816bbe85. PMID: 18448734.

Filippo Murina, MD, Roberto Bernorio, MD, and Rosanna Palmiotto, MD. The Use of Amielle Vaginal Trainers as Adjuvant in the Treatment of Vestibulodynia: An Observational Multicentric Study. Medscape J Med. 2008; 10(1): 23. PMID: 18324333

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