Language of Love with Dr. Laura Berman - Why Is Sex Painful? Let’s Talk About It

Episode Date: October 28, 2024

Have you ever wondered why something meant to be pleasurable can sometimes feel uncomfortable or even painful? In this Language of Love Bite, I tackle an important issue we don’t discuss nearly enough—pain during sex. This common experience affects up to 75% of women at some point in their lives, but the good news is that you don’t have to just live with it. There are real reasons behind it, and more importantly, real solutions! I walk you through the top causes of painful sex, from dryness and pelvic floor issues to more complex conditions like endometriosis. By the end of this episode, you gain the tools and knowledge to address the pain and rediscover pleasure. We break down the different types of sexual pain and explore what triggers them. Whether it’s hormonal shifts, skeleton-muscular issues , or underlying medical conditions, I provide tips and treatments to help you take back control and enjoy intimacy without discomfort. In this Bite I share:  Common causes of sexual pain The role of hormonal changes in causing vaginal dryness and discomfort Vaginismus and how involuntary muscle contractions make intercourse painful Various medical conditions like endometriosis and interstitial cystitis that can lead to sexual pain Effective treatments such as pelvic floor physical therapy, hormone therapy, and medical evaluations Why using the right lubricants can make all the difference Need for medical evaluation to identify underlying issues Struggling with pain during sex? You don’t have to suffer in silence. Explore APTA (American Physical Therapy Association) to find pelvic floor therapists. Want to deepen your connection with your partner? Check out my course on Quantum Sex to learn how to elevate your love life.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm sex, love, and relationship therapist, Dr. Laura Berman, and for the last 30 years, I've been helping people just like you learn to love and be loved better. Welcome to the Language of Love Bites, where I tackle your most asked questions and requested topics. These episodes are designed to be fun, quick, and to the point. It's time we all become fluent in the language of love. As many as 75% of women are experiencing pain during sex at some point in their lives or in their relationship. And that's according to the American College of Obstetricians and

Gynecologists. Sex is not supposed to hurt. And there are many, many reasons why it does. So in this episode, we're going to go through the reasons why, the common reasons why sex may hurt, and then we're going to get into what you can do about it, okay? So the most common reason that I find that sex hurts women is because of dryness. So there's two kinds of pain. When women tell me they have pain, I really ask them to describe it, and it kind of falls into two categories. One is like this painful, raw, almost like feels like sandpaper on the inside of their

vagina pain, which is usually something to do with blood flow and lubrication or sometimes some infection or it's deep aching, like sharp or aching pain, which may be related to some sort of pelvic floor issues, skeletal muscular issue, medical condition. We're going to get into all the reasons. But it's important to understand that there are different kinds of pain, first of all. So let's just go with the top level, pain due to dryness. So this happens often after childbirth because a woman's hormones, especially if she's breastfeeding, in order to produce milk, her hormones basically have to go to the same level that a menopausal woman's hormones are.

So for menopausal women and for breastfeeding women, your estrogen levels are very low. Estrogen is what is responsible as the hormone that plays the largest role in lubrication. And we can get it. I won't spend a lot of time. I could get into how lubrication happens and why it happens. But basically, the lower a woman's estrogen levels are, and they start to decline in our late 30s. But a woman in her 60s has half the estrogen that a woman in her 20s has.

So it's slowly declining throughout our lifespan and it definitely bottoms out when we're breastfeeding and it can take up to six months after we finish breastfeeding in order for our hormones to re-equilibrate. So it's really common to have dryness during that period in a woman's life and during perimenopause and menopause and after chemotherapy, if she's had any kind of cancer and if she's on any estrogen blocking therapies as a result of cancer, like tamoxifen, all of those things will negatively affect her estrogen levels, which will negatively affect her lubrication, which will make sex painful. The nice thing is that there's a relatively easy fix,

lubricants and lots of foreplay. Okay. So lots of lubrication and lots of foreplay. Lubrication, you want to really use the most natural and organic lubricants you can find because the vagina is a mucous membrane, just like inside your eyes and nose and mouth. So That means things go directly into the bloodstream. My favorite lubricant, honestly, to recommend if you aren't allergic to coconuts is coconut oil. The same stuff you would cook with, organic coconut oil, is an amazing lubricant. But you can also buy organic lubricants in most drugstores or online stores. And you want to do a lot of foreplay and start off slow.

Now, the tricky part with all pain, including pain related to dryness, is that a lot of women develop a condition when they start to have pain, they have a physical reaction to it and accidentally create this secondary condition called vaginismus. Now we see this in a lot of victims of rape or sexual molestation or sexual abuse, but we also see it in a lot of women who have experienced any kind of pain. It's an involuntary clenching of the muscles in the outer third of the vagina that can make having intercourse almost impossible or painful. It can even make having a gynecological exam unbelievably painful. It's not being done on purpose. It's the body's automatic reaction to pain. And then even once you start incorporating

lubrication or other strategies, the vaginismus sometimes remains, which leads me to the second thing that really helps with pain, which we'll get to in a moment, which is gynecological or pelvic floor physical therapy. We'll put a pin in that for a second because I want to go into the other causes. Other causes of genital pain or pain in general during sex, endometriosis, okay? That's where the tissue that normally is inside the uterus grows on the lining of the uterus, grows outside in other areas of the pelvis, such as the ovaries or the fallopian tubes or even the intestines. And it can be unbelievably painful, especially closer to getting her period when that tissue is building up inside the uterus. It's also building up outside

and it's creating a lot of pain because the uterus kind of moves during penetration. And as that's happening, it's causing pain, especially in women with endometriosis. Same thing with interstitial cystitis, also known as painful bladder syndrome. That is usually and often mistaken for a urinary tract infection because it has a lot of the same symptoms, but it's bladder pain, pressure, frequent urge to urinate, and it's going on and antibiotics aren't curing it. You know, you definitely want to go to a doctor if there's any kind of genital pain, because you want to make sure that you don't have any of these medical conditions. Hey, it's Dr. Laura Berman. I've been a sex, love, and relationship therapist for over 30 years. And

the main question I always get asked is how the heck do we spice it up in a long-term monogamous relationship? Well, if you want to take your love life, your sex life to the next level, whether you're in a relationship or not, check out my free course on quantum sex. It's going to teach you how to take your sexual response to the next level, capable of full body orgasms, how to use sex magic to manifest your dreams, and how to connect on an even deeper level sexually with your partner. Just go to drlauraberman.com and you'll find it right there on the homepage, the quantum sex free course. Check it out. Let me know what you think. If you've had any kind of injury to your pelvic floor, your pelvic floor, the muscles,

that kind of hold up all a woman's reproductive organs. So that could have happened through childbirth, vaginal childbirth, or even falling on a boy's. I've had women who fell on a boy's bicycle bar when they were riding as a kid that can cause pain during sex. Vulvodynia is another common cause of pain. That is chronic pain around the opening of the vagina. So it can be burning and stinging, soreness, itching. It's usually around that if you're looking at the vagina and a woman is lying on her back, it's usually like in the 10 to 2 area. But that is a chronic condition that sometimes is a cause of allergies to detergents or fabrics

that are coming in contact with that area. Medications she's taking, medical conditions, infections, genital infections, a bacterial or a yeast infection, or even a sexually transmitted infection can cause pain during sex as can ovarian or uterine cysts or fibroids. Now cysts are fluid filled sacs that develop on the ovaries, typically have no symptoms, but if they rupture, they can cause pain and bleeding and fibroids are non-cancerous growths that can grow in the uterus and cause heavy menstrual bleeding and pelvic pressure and painful intercourse. And then there is pelvic floor dysfunction, which is what vaginismus would fall into that category when you tighten

involuntarily, when you tighten your vaginal muscles or even your pelvic floor muscles. So those, along with hormones, the hormonal changes I already mentioned, are some of the common reasons why women have pain. So the treatments, yes, lubricants, especially if it's pain related to dryness, and also sometimes reviewing your medications, treating any infections or medical conditions, making sure you're being checked out by an OBGYN and that there are no chronic conditions, medical conditions, or infections that are at play here. And then also, if you are a candidate for it, considering hormone therapy. Now, not all women, you know, if you had an estrogen sensitive cancer or there's some other reason why you can't or

don't want to take hormones, then, you know, it's not for everyone. But honestly, there are topical estrogens. So for women who are in the perimenopausal phase in their mid to late 30s and beyond, even for women who are breast cancer survivors, there was a study called the STAR study that showed that locally delivered estrogen in the form of a product called S string, which is like a silicone ring that gets inserted into the vagina and stays there intermittently gets changed out. But it's like an estrogen impregnated ring that just locally delivers estrogen to the inside of the vagina. There's also a product called Vagifem, which are these little estrogen pellets that get inserted almost like with a tampon like thing that adhere to the walls of

vagina and dissolve there and estrogenize the vagina. The cool thing about both of those is that they are minimally to not at all absorbed into the bloodstream in a way that changes the body's hormone levels. So it's not going to change your estrogen levels in a way that is considered to put you at risk. I mean, obviously talk to your doctor. I'm not an MD. I'm a PhD. You got to talk to your doctor about this, but Lord knows I've ushered thousands of women through this. So talk to your doctor about those if you have low estrogen levels and are experiencing pain and dryness, because you can re-estrogenize the vagina even if you don't want to take systemic estrogen, which a lot of women do, especially as they move into menopause. A lot

of women don't, but a lot of women do as well, especially because the more recent knowledge and understanding is that even though for 20 years they've been saying that estrogen can cause breast cancer, they're now acknowledging, which I was saying just for the record 20 years ago, that those studies they were going by were deeply flawed and that is actually not true. And estrogen can have very significant protective effects. So doctors are going back to prescribing estrogen to women and when they're entering the menopausal phase, but that is something to talk to your doctor about. The other thing that really, really helps is something called, and this is what I put a pin in, the gynecological or pelvic floor physical therapy. It's shocking to me how

few doctors and even OBGYNs know about this and how unbelievably important it is, especially if you're experiencing any kind of genital pain, especially during intercourse. So you can find a physical therapist like this if you go to the physical therapy organizations. So in the United States, the APTA.org, the American Physical Therapy Association website. You look under women's health and you can find a whole array of certified physical therapists in women's health and pelvic floor and gynecological physical therapy. If you get a referral from your OBGYN, insurance will almost always pay for it, especially if there's pain. It is very sad and also ironic but most insurance companies will pay for treatment for genital pain that prevents a

woman from having sex. They won't pay for things that make sex more pleasurable, but they will pay for things that keep her from having sex. So if she's having pain, most insurance companies will pay for the physical therapy, which is a great perk. And what the physical therapist does is they will go in there and first and foremost see if there is any skeletal muscular dysfunction, maybe it happened during an injury or childbirth or something else that is causing the pain. Because sometimes it's actually a malfunction or a misalignment that has happened in the pelvic floor or in the skeletal muscular system around that area, anywhere in the pelvis. The second thing, so they'll assess and evaluate,

And then they will also use biofeedback and physical therapy to interrupt the vaginismus, that involuntary clenching, to help you become more aware of relaxing those muscles and tightening those muscles at your will. And they will treat any skeletal muscular issues that have developed either as a result of the pain in the vaginismus or what caused the pain in the first place. I have found them unbelievably effective. every single woman that I ever treat who has pain. I make sure they go to see a physical therapist like this. I also send women who can't have orgasms to someone like this because

sometimes there's a pelvic floor dysfunction that's making the muscles too loose that is actually impeding their ability to orgasm, which is interesting as well. But that's a subject for another video another time. For now, I will say pain is not normal. You don't need to live with pain. You don't need to avoid sex because of pain. It can be treated. You just may have to go to a few doctors to get there. So please don't suffer in silence and know that help is available. If you have any questions on this or any topic I cover, you can always email me at languageoflovepod at gmail.com or you can comment. I am always here to help you learn to love and be loved better. I went to the doctor, said I'm crazy for your love

Wrote me a prescription