Dyspareunia (painful intercourse) refers to pain in the pelvic area during or after intercourse, and can occur in both women and men.
Besides possible physical causes, pain may occur in association with psychological factors such as previous sexual trauma.
A pelvic exam can confirm the diagnosis.
A medical history and complete physical exam are needed to look for other causes of pain with sexual intercourse.
Dr. Bonita Kolrud, a specialist in Obstetrics and Gynecology with Riverview Family Clinic in Wisconsin Rapids, is here to explain what can be done to help you with painful intercourse.
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Treatment For Painful Intercourse
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Learn more about Dr. Bonita Kolrud
Bonita Kolrud, MD
Dr. Bonita Kolrud is a specialist in Obstetrics and Gynecology with Riverview Family Clinic in Wisconsin Rapids.Learn more about Dr. Bonita Kolrud
Transcription:
Treatment For Painful Intercourse
Melanie Cole (Host): If sex doesn’t always feel so pleasurable, you’re not alone. According to the national survey of sexual and behavior, up to 30% of women reported pain during their last sexual encounter. Just because it’s common doesn’t mean it’s okay. My guest today is Dr. Bonita Kolrud. She’s an obstetrician/gynecologist with Aspirus Health System. Welcome to the show, Dr. Kolrud. Tell us, how common is painful sex and why do women have such a hard time discussing this with their doctors?
Dr. Bonita Kolrud (Guest): Good morning, Melanie. Painful sex is present 30-40% of the time. Women have trouble talking about it with their doctors. I think, for the most part, they just don’t bring it up. Sometimes their partner brings it up. The doctor – we try to bring it up when we go over the medical history and, usually, people will open up about it if we ask the right questions.
Melanie: What are some causes that women might have for painful intercourse?
Dr. Kolrud: Well, what are some causes, did you say?
Melanie: Yes. What are some of the reasons that you could point to or look for when a women comes to you and says that intercourse is becoming painful?
Dr. Kolrud: Well, we start with the history—the sexual pain history. Some of the reasons would be a history of infection if they’ve had a prior pelvic infection, depression, history of abuse, of course, can be one of the reasons, anxiety, or being post-menopausal and not having enough estrogen. In addition, there could be pelvic pathology, if they’ve got a large uterus or ovarian masses. Endometriosis is a common cause for pelvic pain.
Melanie: So, let’s start with possible menopause, perimenopause and post-menopausal women. If they don’t have enough estrogen, this might be something that might be a little bit easier to diagnose if you know that’s what they’re going through. What do you tell them about that?
Dr. Kolrud: Definitely, that would be one of the easiest scenarios to treat and it responds well. The discomfort of lovemaking when you don’t have enough estrogen responds very well to estrogen replacement. We can use local estrogen products which come in creams, tablets, rings or we use systemic estrogen replacement, if that’s appropriate. The vagina will respond very quickly to proper estrogen.
Melanie: Okay. So then, if it is something like endometriosis, you might have known about this, as you say, in their history. What can you do? What are some treatments available that women can do? Are there topical treatments, surgical interventions? What do you do for them?
Dr. Kolrud: Well, if it was endometriosis, that has a long list of treatment options and that normally is something that is diagnosed during the reproductive years. Treatment options include hormones, surgery, typically, we are using either something hormonal or surgery for endometriosis. That’s one of the tougher ones to treat – pelvic pain--when there’s endometriosis present.
Melanie: So, you mentioned a few others, Dr. Kolrud, like anxiety and stress. How do those play a role in pelvic pain during intercourse?
Dr. Kolrud: Well, when we’re talking about anxiety or stress, we do want to get a good history about whether or not this is associated only with this partner or if it’s associated with all partners. There can be therapy involved with a sexual therapist, especially if there’s a history of abuse. Those are situations where normally we have a sexual therapist involved to work with the couple.
Melanie: How does that work with a sexual therapist helping if it’s stress or anxiety or, even if it’s not a history of abuse, if it’s painful to have sex, could that be an intimacy issue as well?
Dr. Kolrud: Absolutely. The therapist is going to be visiting with them about what’s going on in their relationship. They will be giving them some ideas as far as relaxation techniques, you know, all of the foreplay options that there are for the couple to work together. There are a lot of things they’re going to cover if it’s in that category of intimacy.
Melanie: How does somebody practice maybe vaginal relaxation or are there other sort of lifestyle and home remedies that you can recommend? Switching positions or lubricants? Can any of those help with this?
Dr. Kolrud: All of those things we go over but, usually, the couple has already tried those things with lubrication and changing positions. I think oftentimes, couples don’t commit to taking time for themselves and leaving the home, maybe getting a hotel room. They don’t commit to making the time for the children to maybe go somewhere else and stay with another provider so they’ve got some time alone or a vacation.
Melanie: A vacation. Certainly! We all need that. That might certainly help. What about medications? Are there any medications that you ever recommend for this that can help if it’s not endometriosis?
Dr. Kolrud: If there is discomfort right at the vaginal opening, we oftentimes would use a local anesthetic jelly which really does help with that portion of lovemaking--with penetration. Of course, there has to be the appropriate amount of estrogen in the vaginal tissue. Beyond that, we don’t normally recommend an anti-anxiety medication or something like that. That would be kind of last resort.
Melanie: In just the last few minutes, Dr. Kolrud, give women listening your best advice if they are hesitant to talk to their doctor about painful intercourse.
Dr. Kolrud: Best advice? Just to bring it up. I think most doctors are happy to talk about painful intercourse. Most of us have had a lot of experience over the years with it. Just bring it up. I think docs like to talk about having a healthy sexual relationship for the couple. Most docs are very open to talking about it.
Melanie: Tell us about your team at Aspirus.
Dr. Kolrud: We have a very good team locally and throughout the state involving ob/gyns, urogynecologists, internal medicine, the complete medical team to help women have a satisfactory sex life among other healthy conditions.
Melanie: Thank you so much, Dr. Kolrud. You’re listening to the Aspirus Health Talk. For more information you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.
Treatment For Painful Intercourse
Melanie Cole (Host): If sex doesn’t always feel so pleasurable, you’re not alone. According to the national survey of sexual and behavior, up to 30% of women reported pain during their last sexual encounter. Just because it’s common doesn’t mean it’s okay. My guest today is Dr. Bonita Kolrud. She’s an obstetrician/gynecologist with Aspirus Health System. Welcome to the show, Dr. Kolrud. Tell us, how common is painful sex and why do women have such a hard time discussing this with their doctors?
Dr. Bonita Kolrud (Guest): Good morning, Melanie. Painful sex is present 30-40% of the time. Women have trouble talking about it with their doctors. I think, for the most part, they just don’t bring it up. Sometimes their partner brings it up. The doctor – we try to bring it up when we go over the medical history and, usually, people will open up about it if we ask the right questions.
Melanie: What are some causes that women might have for painful intercourse?
Dr. Kolrud: Well, what are some causes, did you say?
Melanie: Yes. What are some of the reasons that you could point to or look for when a women comes to you and says that intercourse is becoming painful?
Dr. Kolrud: Well, we start with the history—the sexual pain history. Some of the reasons would be a history of infection if they’ve had a prior pelvic infection, depression, history of abuse, of course, can be one of the reasons, anxiety, or being post-menopausal and not having enough estrogen. In addition, there could be pelvic pathology, if they’ve got a large uterus or ovarian masses. Endometriosis is a common cause for pelvic pain.
Melanie: So, let’s start with possible menopause, perimenopause and post-menopausal women. If they don’t have enough estrogen, this might be something that might be a little bit easier to diagnose if you know that’s what they’re going through. What do you tell them about that?
Dr. Kolrud: Definitely, that would be one of the easiest scenarios to treat and it responds well. The discomfort of lovemaking when you don’t have enough estrogen responds very well to estrogen replacement. We can use local estrogen products which come in creams, tablets, rings or we use systemic estrogen replacement, if that’s appropriate. The vagina will respond very quickly to proper estrogen.
Melanie: Okay. So then, if it is something like endometriosis, you might have known about this, as you say, in their history. What can you do? What are some treatments available that women can do? Are there topical treatments, surgical interventions? What do you do for them?
Dr. Kolrud: Well, if it was endometriosis, that has a long list of treatment options and that normally is something that is diagnosed during the reproductive years. Treatment options include hormones, surgery, typically, we are using either something hormonal or surgery for endometriosis. That’s one of the tougher ones to treat – pelvic pain--when there’s endometriosis present.
Melanie: So, you mentioned a few others, Dr. Kolrud, like anxiety and stress. How do those play a role in pelvic pain during intercourse?
Dr. Kolrud: Well, when we’re talking about anxiety or stress, we do want to get a good history about whether or not this is associated only with this partner or if it’s associated with all partners. There can be therapy involved with a sexual therapist, especially if there’s a history of abuse. Those are situations where normally we have a sexual therapist involved to work with the couple.
Melanie: How does that work with a sexual therapist helping if it’s stress or anxiety or, even if it’s not a history of abuse, if it’s painful to have sex, could that be an intimacy issue as well?
Dr. Kolrud: Absolutely. The therapist is going to be visiting with them about what’s going on in their relationship. They will be giving them some ideas as far as relaxation techniques, you know, all of the foreplay options that there are for the couple to work together. There are a lot of things they’re going to cover if it’s in that category of intimacy.
Melanie: How does somebody practice maybe vaginal relaxation or are there other sort of lifestyle and home remedies that you can recommend? Switching positions or lubricants? Can any of those help with this?
Dr. Kolrud: All of those things we go over but, usually, the couple has already tried those things with lubrication and changing positions. I think oftentimes, couples don’t commit to taking time for themselves and leaving the home, maybe getting a hotel room. They don’t commit to making the time for the children to maybe go somewhere else and stay with another provider so they’ve got some time alone or a vacation.
Melanie: A vacation. Certainly! We all need that. That might certainly help. What about medications? Are there any medications that you ever recommend for this that can help if it’s not endometriosis?
Dr. Kolrud: If there is discomfort right at the vaginal opening, we oftentimes would use a local anesthetic jelly which really does help with that portion of lovemaking--with penetration. Of course, there has to be the appropriate amount of estrogen in the vaginal tissue. Beyond that, we don’t normally recommend an anti-anxiety medication or something like that. That would be kind of last resort.
Melanie: In just the last few minutes, Dr. Kolrud, give women listening your best advice if they are hesitant to talk to their doctor about painful intercourse.
Dr. Kolrud: Best advice? Just to bring it up. I think most doctors are happy to talk about painful intercourse. Most of us have had a lot of experience over the years with it. Just bring it up. I think docs like to talk about having a healthy sexual relationship for the couple. Most docs are very open to talking about it.
Melanie: Tell us about your team at Aspirus.
Dr. Kolrud: We have a very good team locally and throughout the state involving ob/gyns, urogynecologists, internal medicine, the complete medical team to help women have a satisfactory sex life among other healthy conditions.
Melanie: Thank you so much, Dr. Kolrud. You’re listening to the Aspirus Health Talk. For more information you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.