Ask the Doctors: Sex Makes Me Sore
Dear Dr. Queen,
What a relief to know that doctors like you exist. I’ve brought questions to my PCP before, but even though the topic wasn’t even all that esoteric, she had no idea how to advise me. I’m hoping you might be able to point me in the right direction of where I might go for advice.
I’m a female-gendered/bodied woman in love with a wonderful male-gendered/bodied man, with whom the sex is phenomenal. He’s thoughtful, giving and careful, with the most amazing communication abilities I’ve ever met in a person. We have a history of amazing sex, but what with one thing and another–stress? age? who knows?–I’ve started to get more and more sore during and after sex. He’s pretty well endowed, and built in such a way that he hits everything in me that feels incredible. Even if he checks in with me to make sure I’m doing okay, I find it hard to ask him to stop because it feels so good even though I know it’s going to hurt afterwards.
It’s primarily a stinging kind of pain around the entrance to the vagina. During particularly vigorous sessions, things will tear just enough (even with lube!) that when I go to the bathroom afterwards, the toilet paper will come away just a little bit bloody. It’s at the worst in the back, so whenever we have penetrative sex, he’s careful to try not to drag on it too much. Because it seems linked to how tense the muscles are right behind the bottom/back of my vagina is, the vaginal massage I’d mentioned helps, but unfortunately not enough. (The funny thing is, once upon a time I’d been worried about my vagina getting looser and being less tight/enjoyable for partners. Funny how the body will provide what you ask for, whether or not it’s good for you.)
So, my question is this: what might you recommend we do to keep having this amazing penetrative sex, but help my body to not get (as) hurt? We use as much Pjur lubrication as needed in a given session, massage my vagina before sex to try to help relax the oh-so-tense at the back of the opening that is the most easily torn area, and are looking into smaller dildos for me to enjoy while we’re doing other sexual activities. Of course sex is about more than just penetration, but I enjoy it so much: I’d like to work with the tense vagina, rather than give up on it except for rare penetrative sex. Knowing my body and how it responds to sex is a life-long process, and he and I have many decades to figure out long-term sex solutions.
If there’s anything I learned in sex ed, it’s “you’re not alone,” so if I’m having this problem, I imagine there are other women who could use the same advice. Do you have any thoughts as to what we might be able to do? Other resources you might recommend we check out? I’m up for anything: single or couple exercises, different toys, a different kind of lube, whatever.
–“Pleased But Pained”
You don’t say specifically how old you are. One thing that might affect your experience, the hormonal changes of menopause, can alter how quickly you get physically aroused (different though linked to how mentally/emotionally aroused you still are by your partner — I don’t mean how attracted you are, but how quickly and how much you respond with wetness and the other effects of increased blood flow to the genitals).
Arousal, on one level, IS blood flow, which makes the vulva and vaginal tissues more flexible and engorged, causes vaginal wetness to exude, and suffuses muscles, nerves and everything. Proceeding to penetration too soon — before your body is ready, though the spirit can be more than willing <g> — would mean that the muscles are more tense, the vulvar and vaginal skin less flexible and perhaps more easily abraded. Using lube is great — but this situation can actually be masked by lube, because you don’t need to wait to get more slippery for penetration.
One possibility, therefore, is that your years of experience with your partner have led you both to a sexual pattern that is no longer completely adequate for your “warm-up” needs. Massage is helping relax your muscles but also is probably serving an erotic function and assisting with blood flow, but possibly not as much as you need.
It’s also conceivable that your lube choice is irritating to you, though we don’t hear much about that with silicone lubricants. Water-based ones can have more varying ingredients that cause some people irritation while not bothering others a bit. It is also the case for some women that using bleached menstrual products or too-harsh chemicals to wash or launder clothing predisposes them to these kind of problems, or seems to. If you ever use chemical douches, stop! Don’t even allow soap at the opening of your vagina — wash with water and keep any soap use up in your pubic hair (if you still wear any. And if you don’t, make sure your method of hair removal is not causing or exacerbating irritation).
Vulvodynia — vulvar pain — is not just associated with menopause. Also, serious vulvodynia isn’t just associated with sexual contact — the vulva can burn, itch, sting or hurt all the time, or intermittently. I am not suggesting that what you experience is necessarily vulvodynia, though it might be. Persistent inflammation, though — which is associated with this condition — comes from somewhere. Persistent pain can result in increased inflammation and can be caused by it.
Here’s one take on the condition, according to an article on WebMD: “The experts tell WebMD that among the many theories about what causes vulvodynia, the most likely is a response to tissue abnormality, possibly caused by infection, irritation, or trauma long after it’s been resolved. ‘I think most people believe this is chronic regional pain syndrome, or CRPS,’ says [Howard] Glazer, [PhD]… [W]hen soft tissue gets irritated or damaged, the body activates a number of defenses. The tissue becomes inflamed and puffs up like a protective pillow to prevent further contact. New nerve endings grow and become hypersensitive so they can detect further contact and withdraw. Blood vessels in the area shut down to prevent possible infection from traveling to the rest of the body. Finally, muscles go on the defensive, producing spasms in the pelvic floor which reduce blood flow and produce further inflammation.” (Glazer is identified as a neurophysiologic psychologist who specializes in pain management and sexual dysfunction, and he has an interesting and substantial website: www.vulvodynia.com.)
If all that sounds too familiar, perhaps seeking a physician for whom CRPS or vulvodynia are specialties might be worthwhile. You are not alone in finding that your MD can’t offer much in the way of knowledge and advice. While some doctors specialize in vulvovaginal conditions, most get almost no training about how to deal with issues of the female genitals. If you can get to a specialist or a clinic focusing on pelvic pain, try to do so. (Our local San Francisco clinic might be able to refer you to one closer to you: http://www.pelvicpainrehab.com/.) If you talk to a doc who suggests surgery or steroids, go to a different doc. At your next doctor visit, get tested to rule out diabetes as well as any vaginal irritants like yeast infections.
Besides the sensitivity issues I mentioned above, you might wish to consider another possible source of skin inflammation: food allergy or sensitivity. This is not the sort of thing most people would associate with sexual problems, but our genitals are one of the many areas of the body that can be affected by chronic inflammation. Some doctors look at oxalates in the blood and recommend a low-oxalate diet; this is somewhat controversial. But anything that increases overall inflammation (celiac disease, for example) could be a culprit or an exacerbating factor. If you have any other inflammation-related issues, you might consider learning more about specialized diets and especially starting a food diary to track what, if anything, you’re ingesting that may affect sexual functioning and anything else about your physical body and its well-being.
Look carefully at your habits and rule out any other sources of irritation — too-tight jeans, riding a bike, horse, or rowing machine, wearing tight panties that don’t breathe (cotton-only while you are dealing with this, and no thongs, which will rub right over the affected area repeatedly). This goes double if you tend toward vulvovaginal moistness — we have sweat glands there, and if your garments are holding it against your body, it can cause or exacerbate irritation.
You might also appreciate this book: The V Book: A Doctor’s Guide to Complete Vulvovaginal Health, co-authored by Elizabeth G. Stewart, MD. (Here’s her site for the book: http://www.thevbook.com/.) I also like the work of Dr. Christiane Northrup, who incorporates a holistic, mind/body awareness of health issues with her medical training.
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