What to do when you experience painful sex or a lack of desire?

 

Comprehensive Sexual Wellness

Although many women brush off intimate health as not being important for overall wellness, this way of thinking is quite misguided.  Our sexual wellbeing is vital for many reasons, and not something to disregard.  Too many women don’t feel comfortable discussing painful sex with their GYNs, but it’s one of my favorite topics to address!  Nearly half of women (although I believe that is a remarkable underestimate) struggle with painful sex or sexual dys-health at some point in their lives.  Along the same lines, over 60% of women suffer with some level of urinary incontinence and nearly 50% of women suffer with pelvic organ prolapse.  So you aren’t alone, but can we do about our sexual wellness?

We may struggle with sexual wellness for a variety of reasons throughout our lives.  Where is your libido hiding? It’s not just a hormone imbalance, or any other one singular issue.  It can hide behind stress, chronic illness, medication side effects, cognitive distortions about yourself, past trauma, relationship challenges, and many other brick walls:

  • general unhealth and other physical/mental/emotional conditions

  • loss of pelvic strength and sensation from pregnancy and/or childbirth

  • changes in hormones postpartum and through peri- and post-menopause years

  • traumatic experiences and relationships

  • getting “too busy” and “out of practice” with all of life’s other demands

  • pelvic injuries or infections

  • medications like anti-depressants and blood pressure meds

  • loss of confidence and comfort with your body

  • and general loss or lack of maintenance of physical conditioning, just to name a few

 
 
 

WHAT DO YOU FEEL ARE YOUR BIGGEST CONTRIBUTORS?

There are many components to sexual wellness and, to be healthy in this area, they ALL need to be addressed.  Leaving out any component that needs attention will leave you falling short! Traditionally, in gynecology, we categorize sexual “dysfunction” into four different categories –

 

1) Desire disorder – lack of sexual desire or interest in sex,
2) Arousal disorder – inability to become physically aroused or excited during sexual activity,
3) Orgasmic disorder – delay or absence of orgasm (climax), and
4) Pain disorder – painful sex.  Though, these often co-exist and overlap for many women. 

 
 

So, how do you work towards sexual wellness in YOUR LIFE?

If you have seen us before (or another GYN!) and addressed only part of these steps, make sure to note what areas you haven’t yet given attention/resolved, and don’t give up!  If you’ve started a treatment plan, and haven’t yet reached a place that you are happy with, make sure to continue to take the next step.  Sometimes, you DO have to try a combination of multiple different approaches and/or move on to a new approach if something isn’t working completely.  Sometimes it does take some time for one approach to build on top of the other to make significant improvements.  Sometimes, we start by addressing one or two things, but if this starting point is not complete for you, we need to continue forward, so stick with it!

 

  • Schedule a visit for an GYN evaluation and exam – in this visit, we will note any physical vaginal and/or pelvic issues that are present, as well as consider a blood hormone evaluation. These findings can be systematically addressed with therapies that may include, but are not limited to: vaginal or systemic hormone therapy, treatment of pelvic/vaginal infections or inflammatory issues, referral for physical therapy or other strengthening/muscle conditioning exercises for the pelvis and vagina, topical or other therapies to improve arousal, vaginal/clitoral Platelet Rich Plasma (PRP) that can help with sensation and lubrication, as well as orgasmic function and mild urinary incontinence.

  • If you have health concerns and/or issues that are currently un-resolved or un-addressed (such as obesity, pain or fatigue syndromes, metabolic issues, autoimmune issues, thyroid or other hormone/inflammatory issues, or other chronic health conditions, we will help you better address root causes and empower you to lifelong improvement.

  • Determine if you would benefit from vaginal/clitoral Platelet Rich Plasma (PRP) injection. This therapy involves a series of injections of PRP into your vaginal and clitoral tissue, which can be done in the office. PRP is extracted from a draw of your own blood, and can improve tissue quality. It is used extensively in the orthopedic and dental worlds, as well as in treating hair loss, and can be useful in GYN, too. It can help with lubrication, orgasmic dysfunction, and urinary incontinence. While it may not completely resolve your concerns as a stand-alone therapy depending on what you have going on, it can be a helpful adjunct to your overall treatment approach when initial therapies have provided incomplete relief.

  • Determine if you would benefit from either individual or relationship counseling. This is vital if stress, anxiety/depression, prior trauma, or relationship issues are part of what is impacting your sexual wellness. Leaving this area unaddressed/suppressed will never end well! Working with a counselor, trauma therapist, sex therapist, or coach can be remarkably helpful. It is also important to work on developing your own self-awareness and mindfulness practices.

  • Be willing to spend a little time on this area of your life! As with everything we want to improve or develop, there essentially are never “quick fixes” or stand-alone magical therapies. Set aside 10 minutes before bed each night for pelvic floor/vaginal strengthening, if needed. Set aside several times a week completely devoted to intimate time with your partner (not necessarily sex, as that can create counter-productive emotional pressure in the beginning, but “cuddle” time) – I recommend at least 3-4 times per week, with one being substantially longer, at least an hour. Our vaginal and pelvic floor muscles, as well as our hormone responsiveness, will atrophy (just like the rest of the body) and become numb without use and practice, so patience and persistence is important! Dig inside yourself (and your partner) to consider what your roadblocks really are. Sexual wellness is usually a combination of psychological, emotional, physical, and spiritual healing.