This is one that affects mostly women, with 43% of American women reporting such issues at some point. There’s a distribution curve to this, with higher incidence in younger and older women; younger while first figuring things out, and older with menopause-related body changes. But, it can happen at any time (and often not for obvious reasons!), so here’s what OB/GYN Dr. Jennifer Lincoln advises:
Many possibilities, but easily narrowed down
Common causes include:
- vaginal dryness, which itself can have many causes (half of which are “low estrogen levels” for various different reasons)
- muscular issues, which can be in response to anxiety, pain, and occur as a result of pelvic floor muscle tightening
- vulvar issues, ranging from skin disorders (e.g. lichen sclerosis or lichen planus) to nerve disorders (e.g. vestibulitis or vestibulodynia)
- uterine issues, including endometriosis, fibroids, or scar tissue if you had a surgery
- infections, of the STI variety, but bear in mind that some STIs such as herpes do not necessarily require direct sexual contact per se, and yeast infections definitely don’t. Some STIs are more serious than others, so getting things checked out is a good idea (don’t worry, clinics are discreet about this sort of thing)
- bowel issues, notwithstanding that we have been talking about vaginal sex here, it can’t be happy if its anatomical neighbors aren’t happy—so things like IBS, Crohn’s, or even just constipation, aren’t irrelevant
- trauma, of various kinds, affecting sexual experiences
That’s a lot of possibilities, so if there’s not something standing out as “yes, now that you mention it, it’s obviously that”, Dr. Lincoln recommends a full health evaluation and examination of medical history, as well as a targeted physical exam. That may not be fun, but at least, once it’s done, it’s done.
Treatments vary depending on the cause, of course, and there are many kinds of physical and psychological therapies, as well as surgeries for the uterine issues we mentioned.
Happily, many of the above things can be addressed with simpler and less invasive methods, including learning more about the relevant anatomy and physiology and how to use it (be not ashamed; most people never got meaningful education about this!)*, vulvar skin care (“gentle” is the watchword here), the difference a good lube can make, and estrogen supplementation—which if you’re not up for general HRT, can be a topical estrogen cream that alleviates sexual function issues without raising blood serum estradiol levels.
*10almonds tip: check out the recommended book “Come As You Are” in our links below; it has 400 pages of stuff most people never knew about anatomy and physiology down there; you can thank us later!
Meanwhile, for more on each of these, enjoy:
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Want to learn more?
You might also like to read:
- Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier? (counterintuitively, it’s the silicon! But do give it a quick read, because here be science)
- How To Avoid Urinary Tract Infections (may be relevant; always good to know)
- Come As You Are – by Dr. Emily Nagoski (book; if we could only recommend one book on responsible vagina ownership, this would be the one)
Take care!
