What You Need to Know About Sexual Pain

July 31, 2019

Did you know that 30% of women experienced pain during their last sexual encounter? 30%! But as common as it is, sexual pain doesn’t get enough press. There are millions of women suffering in silence, unaware that there are treatment options for their pain. In order to help me cover this important topic, I spoke with Dr. Sonia Bahlani, a pelvic pain specialist based out of New York City.

Painful sex is a serious problem

It is not normal to experience pain during sex, and you deserve to find a doctor who will take your pain seriously.

As striking as that 30% figure is, it’s possible that even more women are suffering from sexual pain. Dr. Bahlani says, “Sexual pain is under-diagnosed because there’s a stigma attached to it. Sex is a difficult topic for most people. They don’t want to talk about it.” Additionally, women are often told that painful sex is normal. My clients have said things like, “My doctor told me that that’s just what sex is like” or “My doctor said to have a glass of wine and try not to think about it.” Women are encouraged not to pursue treatment, or to even think about what they’re experiencing as a problem.

Further complicating matters is the fact that some sexual pain conditions can lessen or even disappear without treatment. Dr. Bahlani says, “If you look at the actual data and history of vulvodynia, pelvic floor dysfunction, interstitial cystitis, it waxes and wanes. People do sometimes get better without doing anything.” Clinicians will often disregard a woman’s complaint because they assume she will get better on her own.

So let’s just be clear: it is not normal to experience pain during sex, and you deserve to find a doctor who will take your pain seriously.

Pain can have multiple causes, and those causes can interact with each other

Dr. Bahlani walked me through a number of potential causes of sexual pain, including:

Pelvic floor muscle issues
Hormones
Neuropathy
Vulvodynia
Endometriosis
Bladder pain/interstitial cystitis
Pelvic inflammatory disease
Uterine fibroids
Psychological causes

This is by no means an exhaustive list—pelvic pain is a complex issue. Pain can also be present in a number of areas in the pelvic region, including different locations on the vulva and in the vagina, the uterus, the bladder, and the musculature. Dr. Bahlani takes a holistic approach to pelvic pain because she recognizes that pain is often multi-faceted. She says, “For me, it’s really important to deal with the entire patient because more often than not, patients have multiple different pain generators. Their pain doesn’t come from one thing. It’s not like having a cold where I give them a single medication and they’re gonna feel better. We often have to deal with every issue on its own.”

Additionally, as Dr. Bahlani addresses one specific cause of her patient’s pain, another factor will often present itself. For example, a woman might have sexual pain from interstitial cystitis. As she continues having sex with her partner, she might start anticipating that pain. The subsequent anxiety that she feels can contribute to her pain. She can even start clenching her pelvic floor muscles in anticipation of the pain, leading to pelvic floor dysfunction. Dr. Bahlani says, “It’s like peeling an onion, I often have to treat one thing, and then see what happens, and treat the other.” Because of the interconnected nature of these contributing factors, Dr. Bahlani recommends searching for a specialist as quickly as possible to avoid these secondary causes of pain. It’s easier to treat interstitial cystitis by itself, without the ensuing anxiety or pelvic floor issues.

There aren’t a lot of specialists, but there are lots of treatment options

We’re able to fix things. We’re able to get you better. It does take time, but there’s so much hope.

There are a shockingly small number of clinicians who are trained in diagnosing and treating sexual pain. Even OB/GYN training barely grazes the surface of sexual pain. Dr. Bahlani says she has clients who fly to her NYC offices from all over the world. She recently started offering telemedicine services so she can work with patients who aren’t able to find a pain specialist in their area. (She’s careful to add that she can’t provide a medical diagnosis over the phone. But a telemedicine appointment can still be extremely valuable and validating.)

Now, for some great news. There are plenty of treatment options for sexual pain, including:

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