Pain associated with sexual intercourse can occur just before, during, or after sex and can have may causes. Pain can be felt at the vulva, inside the vagina, at the bladder or in the lower belly.
Vulvar and vaginal pain in women younger than age 50 can be caused by infections, long-term use of birth control pills, conditions of the skin around the vulva, or vulvodynia. Childbirth can also cause pain in this area for several months afterwards. Vulvodynia is pain at and around the vulva and can be “provoked” or “unprovoked”. Provoked vulvodynia is typically pain felt with insertion of a tampon, speculum, or attempted intercourse. Generalized (or unprovoked) vulvodynia is pain, burning, stinging or irritation anywhere on the vulva. Vaginismus is another cause of painful sex and is thought to be due to the involuntary contraction of pelvic floor muscles. This can occur with anticipated sexual intercourse or with attempted insertion of a tampon or speculum during a gynecologic examination.
For women over the age of 50, the most common cause of painful sex is vulvovaginal atrophy due to menopause. The same can also occur in younger women who have had ovaries removed for cancer treatment or prevention, or who have had other hormonal therapies that incite early menopause. The estrogen deficiency that occurs causes changes in the vaginal skin: thinning of the skin (vaginal atrophy), diminished elasticity and lubrication, and narrowing and shortening of the vaginal canal. These changes lead to symptoms of vaginal dryness, itchiness, and pain with intercourse. Lubricants and moisturizers can help alleviate early symptoms, however the symptoms typically progress and worsen over time. There are various treatment options for vaginal atrophy including vaginal estrogen replacement and fractionated laser therapy (MonaLisa Touch Laser). Dr. DeNoble is on of the first gynecologists in Bergen County and northern New Jersey to offer the MonaLisa Touch laser procedure and performs the procedure in the office.