By Dr. Diana Bitner
I’m thrilled to work with a special guest on this blog post. Dr. Maria Sophocles is a board-certified OB/GYN with more than 25 years of experience. She owns a private practice in Princeton, NJ, and our paths crossed because of her experience with the MonaLisa Touch laser therapy. In fact, she is the one who trained me on how to use this revolutionary therapy on my patients at true. Women’s Health. Dr. Sophocles understands the spectrum of issues women face, from their teens through postmenopause, and she is a wealth of knowledge! In this blog, Dr. Sopholces and I will share some valuable health information for all women, with a special focus on the MonaLisa Touch laser therapy.
Sexual Health IS Health
Sexual health is such an important part of women’s health. I know I’ve said this many times before, and I probably sound like a broken record by now. But, I believe that too many women suffer in silence because either they’re afraid to talk about their sexual health or they’re embarrassed to bring up the topic.
As a leader in women’s health, Dr. Sophocles agrees with me on the importance of making sexual health a topic that all women can discuss without shame, especially with their healthcare providers. Dr. Sophocles refers to it as a “very underrepresented topic.” Often, physicians are too busy with pap smears and yearly physicals that they don’t think to ask their female patients about sexual health and topics like pain with sex. We’re both trying to change the “don’t ask, don’t tell” mentality through blogs like this one and within our medical practices.
Let’s start by discussing painful sex. This can be a lifelong issue for women and can happen at any age. Painful sex can cause women to have a low desire for sex because of the pain they have experienced in the past. Think about it: Would you be excited to have sex with your partner (or even to go on a date) if you were afraid of what might happen when things start to heat up in the bedroom? Painful sex might even be affecting your mood, energy, and self esteem, and keeping you from living your best life. Fortunately, there are solutions and options to help you feel better and stop suffering in silence!
To find the right solution, it’s important to understand the different reasons why you might experience pain with sex. It mainly occurs because of issues with the skin on the outside of the vagina, the skin on the inside of the vagina, tight pelvic muscles, or endometriosis.
Pain on the outside of the vagina
Often times, the issue might simply be a lack of estrogen (especially during and after menopause) that is causing vaginal dryness on the outside. It’s important to know that this is a medical condition that can be treated. Again, you don’t need to suffer! For many women, using estrogen medication may be all that is needed to get their sex life going again.
Another condition on the outside of the vagina, called Lichen Sclerosus, can also be caused by having low estrogen. Even young girls can suffer from this if they are on a low-dose birth control pill that causes dryness. Lichen Sclerosus is very painful but can be treated with corticosteroid ointments or creams.
Pain on the inside of the vagina
A very common reason for painful sex as women age into menopause is a condition we call Genital Urinary Syndrome of Menopause (GSM). Eighty percent of women in menopause suffer from this condition, and a majority have moderate to severe symptoms! Menopause is a state of low estrogen and causes the skin outside (vulva area) and around the bladder opening, and the inside skin of the vagina to become really thin and dry. This condition also causes the mucous glands to dry up; therefore there is no natural lubrication. GSM can also lead to bladder urgency and urgency-related leaking of urine.
The good news is estrogen medication is a simple and effective option to treat GSM.
Pain from tight pelvic floor or endometriosis
For women who experience pain deep inside when having sex, the cause can be endometriosis or tight pelvic muscles (common in women who are elite runners or gymnasts). For women who suffer from high-tone Pelvic Floor Dysfunction, or pelvic muscle spasms, this can happen in reaction to the body’s memory of sexual assault, or because of scar tissue from pelvic surgery. Hip problems and sitting for extended periods of time at work can also cause these same issues. A pelvic floor physical therapist can help with any of these problems; ask your healthcare provider to recommend one in your area. Other solutions include using vaginal valium (such as Diazepam®), a Milli Dilator, or an Ohnut®.
For women who either choose not to use estrogen medication or can’t use it because of a history of estrogen-receptor-positive cancer, there are other options available. One of the best options both Dr. Sophocles and I have found is to use laser therapy on the vaginal area. At true. Women’s Health, we use a device called the MonaLisa Touch. This painless (well, mostly painless) therapy is one of the most effective non-hormonal treatments for painful sex after menopause and has worked incredibly well for my patients at true. The typical regimen is to do three treatments approximately four to six weeks apart. We recommend doing treatment yearly after that.
The MonaLisa Touch laser therapy is also effective in treating GSM (as described above). And, clinical studies have shown that the MonaLisa Touch has helped patients suffering from Lichen Sclerosus.
Five tips to help you with painful sex
- Bring up your concerns about sexual health to your provider. If they are not knowledgeable or comfortable talking about your issue, ask for a referral to someone who knows.
- There are several websites available, including isswsh.org and aasect.org, to help you find a sexual health expert, sexual health counselor, or therapist.
- Understand your family history of endometriosis and pelvic pain. If you’re having pain with deep penetration, it could be a sign of endometriosis.
- Be aware of possible triggers such as exercise, work activities, or prior pain with sex. Check out our Sex Puzzle Cards at true. Women’s Health to help you identify the causes of and treatments for your low sexual desire.
- When you see a provider, be ready with your list of questions and ask for a plan. Get informed about all options and expectations, including possible side effects of each.
Five questions to ask your provider
- I have concerns about my sexual health, including pain with sex. Are you comfortable talking about this?
- If you are comfortable talking about sexual health, what is your background on this topic?
- If you are not comfortable talking about sexual health, what are my options to learn more? Do you have someone to refer me to?
- For any specific concern, ask, “Why is this happening?”
- For any specific concern, ask, “What are the options for treatment and for feeling better?”
When women find out there is a medical reason for their painful sex, they often cry with relief. It’s important to be able to discuss this issue without shame, especially with your healthcare provider. If you are experiencing pain with sex, speak up— there is help and it may be a simple fix.