“Why Does It Hurt When I Have Sex?” (And What To Do About It)

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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:

Take care!

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  • It’s On Me – by Dr. Sara Kuburic

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    This isn’t about bootstrapping and nor is it a motivational pep talk. What it is, however, is a wake-up call for the wayward, and that doesn’t mean “disaffected youth” or such. Rather, therapist Dr. Sara Kuburic tackles the problem of self-loss.

    It’s about when we get so caught up in what we need to do, should do, are expected to do, are in a rut of doing… That we forget to also live. After all, we only get one shot at life so far as we know, so we might as well live it in whatever way is right for us.

    That probably doesn’t mean a life of going through the motions.

    The writing style here is personal and direct, and it makes for quite compelling reading from start to finish.

    Bottom line: if ever you find yourself errantly sleepwalking through life and would like to change that, this is a book for you.

    Click here to check out It’s On Me, and take control of what’s yours!

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  • Simple, 10-Minute Hip Opening Routine

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    Hips Feeling Stiff?

    If so, Flow with Adee’s video (below) has just the solution with a quick 10-minute hip-opening routine. Designed for intermediates but open to all, we love Adee’s work and recommend that you reach out to her to tell her what you’d like to see next.

    Other Methods

    If you’re a book loverwe’ve reviewed a fantastic book on reducing hip pain. Alternatively, learn stretching from a ballerina with Jasmine McDonald’s ballet stretching routine.

    Otherwise, enjoy today’s video:

    How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!

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  • Are You Taking PIMs?

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    Getting Off The Overmedication Train

    The older we get, the more likely we are to be on more medications. It’s easy to assume that this is because, much like the ailments they treat, we accumulate them over time. And superficially at least, that’s what happens.

    And yet, almost half of people over 65 in Canada are taking “potentially inappropriate medications”, or PIMs—in other words, medications that are not needed and perhaps harmful. This categorization includes medications where the iatrogenic harms (side effects, risks) outweigh the benefits, and/or there’s a safer more effective medication available to do the job.

    See: The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study

    You may be wondering: what does this mean for the US?

    Well, we don’t have the figures for the US because we’re working from Canadian research today, but given the differences between the two country’s healthcare systems (mostly socialized in Canada and mostly private in the US), it seems a fair hypothesis that if it’s almost half in Canada, it’s probably more than half in the US. Socialized healthcare systems are generally quite thrifty and seek to spend less on healthcare, while private healthcare systems are generally keen to upsell to new products/services.

    The three top categories of PIMs according to the above study:

    1. Gabapentinoids (anticonvulsants also used to treat neuropathic pain)
    2. Proton pump inhibitors (PPIs)
    3. Antipsychotics (especially, to people without psychosis)

    …but those are just the top of the list; there are many many more.

    The list continues: opioids, anticholinergics, sulfonlyurea, NSAIDs, benzodiazepines and related rugs, and cholinesterase inhibitors. That’s where the Canadian study cuts off (although it also includes “others” just before NSAIDs), but still, you guessed it, there are more (we’re willing to bet statins weigh heavily in the “others” section, for a start).

    There are two likely main causes of overmedication:

    The side effect train

    This is where a patient has a condition and is prescribed drug A, which has some undesired side effects, so the patient is prescribed drug B to treat those. However, that drug also has some unwanted side effects of its own, so the patient is prescribed drug C to treat those. And so on.

    For a real-life rundown of how this can play out, check out the case study in:

    The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

    The convenience factor

    No, not convenient for you. Convenient for others. Convenient for the doctor if it gets you out of their office (socialized healthcare) or because it was easy to sell (private healthcare). Convenient for the staff in a hospital or other care facility.

    This latter is what happens when, for example, a patient is being too much trouble, so the staff give them promazine “to help them settle down”, notwithstanding that promazine is, besides being a sedative, also an antipsychotic whose common side effects include amenorrhea, arrhythmias, constipation, drowsiness and dizziness, dry mouth, impotence, tiredness, galactorrhoea, gynecomastia, hyperglycemia, insomnia, hypotension, seizures, tremor, vomiting and weight gain.

    This kind of thing (and worse) happens more often towards the end of a patient’s life; indeed, sometimes precipitating that end, whether you want it or not:

    Mortality, Palliative Care, & Euthanasia

    How to avoid it

    Good practice is to be “open-mindedly skeptical” about any medication. By this we mean, don’t reject it out of hand, but do ask questions about it.

    Ask your prescriber not only what it’s for and what it’ll do, but also what the side effects and risks are, and an important question that many people don’t think to ask, and for which doctors thus don’t often have a well-prepared smooth-selling reply, “what will happen if I don’t take this?”

    And look up unbiased neutral information about it, from reliable sources (Drugs.com and The BNF are good reference guides for this—and if it’s important to you, check both, in case of any disagreement, as they function under completely different regulatory bodies, the former being American and the latter being British. So if they both agree, it’s surely accurate, according to best current science).

    Also: when you are on a medication, keep a journal of your symptoms, as well as a log of your vitals (heart rate, blood pressure, weight, sleep etc) so you know what the medication seems to be helping or harming, and be sure to have a regular meds review with your doctor to check everything’s still right for you. And don’t be afraid to seek a second opinion if you still have doubts.

    Want to know more?

    For a more in-depth exploration than we have room for here, check out this book that we reviewed not long back:

    To Medicate or Not? That is the Question! – by Dr. Asha Bohannon

    Take care!

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  • Top 10 Causes Of High Blood Pressure
  • The Magic of L-theanine

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    All The Benefits Of Caffeine And More, Without The Drawbacks? What’s The Catch?

    It just takes one extra supplement.

    For many of us, our morning brew is practically a ritual, but caffeine can also cause all kinds of problems ranging from caffeine jitters to caffeine crashes to caffeine addiction and withdrawal. Surely, something could be better?

    Well, yes it could! You doubtlessly know about green tea’s antioxidant properties, but its amino acid, l-theanine (which can be taken as a supplement with coffee, if you don’t enjoy green tea) has so much more to offer:

    • L-theanine has been found to reduce stress responses—and let’s face it, when we most want/need a coffee is often when facing stress
    • It also reduces anxiety, making it a very safe “downer” without the problems of, for example, alcohol—or other potentially addictive substances
    • It’s far more than just that, though! Paradoxically, l-theanine also improves alertness (what other calming things promote alertness? Not so many)
    • Part of its trick is that it also improves accuracy—whereas stimulants like caffeine may produce a twitchy, jumpy, responsiveness, l-theanine’s signature effect is a calm state of sharp readiness. Caffeine works by stimulating the adrenal gland and increasing blood pressure, while simultaneously blocking adenosine receptors so that your body doesn’t notice its own tiredness—which is why you’re likely to crash later, when the tiredness that had been masked, all hits at once. Instead, l-theanine taken with caffeine acts as a moderator of that, making for a longer, gentler curve. In terms of subjective experience, what this can mean for many people is: no more caffeine jitters!
    • All this means that while l-theanine can boost all kinds of cognitive function, including alertness and accuracy, many like to take in the evening as it can also promote a good night’s sleep, ready to be at your best the next day.
    • How much to take? 200mg is a commonly used dosage, which in supplement terms is usually a single capsule. A lot easier to take than the 40 cups of green tea that this dosage would otherwise be!

    Don’t Forget…

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  • The Tiniest Seeds With The Most Value

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    If You’re Not Taking Chia, You’re Missing Out

    Last Tuesday, we wrote about nutritional psychiatry, and the benefits of eating for one’s mental health.

    You can check out Dr. Uma Naidoo’s to-dos, here:

    The 6 Pillars Of Nutritional Psychiatry

    In response, one of our subscribers wrote to mention:

    ❝Really interesting….just put chia seeds in my diet love them……taking the Drs advice.❞

    ~ Cindy, 10almonds subscriber

    And then! On Friday, our tip at the top of the newsletter was:

    Not sure how to incorporate chia seeds into your diet? It’s easier to want the benefits of their many brain-healthy (and otherwise-healthy, too) nutrients, than it is to know what to do with them necessarily, and not everyone enjoys seeds as a snack. So…

    When you cook rice, throw in a tablespoon of chia seeds too. The cooking process will soften them and they won’t be texturally any different than the rice, but the nutrients will be all there.

    They can also be thrown in with lentils, in the same fashion! Or oatmeal, when cooking it or making overnight oats.

    We’ll be honest, it was Cindy’s comment that prompted us to suggest it. But wait! There was more to come in response:

    ❝You had a teaser ..on Chia seed.would of liked a article on the benefits . I’ve just discovered Chia seeds…❞

    ~ Cindy, 10almonds subscriber

    So, Cindy, this one’s for you:

    Nutritional powerhouse

    First things first, these tiny seeds have a lot of nutrients. There are not many more nutrient-dense foods than this (there’s a kind of seaweed that might be a contender; we’ll have to do some research and get back to you).

    Check them out:

    USDA Nutritional Factsheet: Chia Seeds

    So much protein and healthy fat, so many vitamins and minerals, and so many miscellaneous other micronutrients that we’d be here all day to list them (which is why we linked the above factsheet instead).

    Antioxidants in abundance

    These deserve a special mention, because they include quercetin which we’ve written about previously:

    Fight Inflammation & Protect Your Brain, With Quercetin

    …as well as quite a collection of others (including chlorogenic acid and caffeic acid, which may sound alarming but are great for lowering your blood pressure and against inflammation, respectively):

    There are others too, with cardioprotective effects, liver-healthy effects, and anticancer properties:

    Nutritional and therapeutic perspectives of Chia (Salvia hispanica L.): a review

    Good for the heart and blood

    Check it out:

    Oh, and about diabetes? There’s more, this time pertaining to reducing after-dinner blood sugars (or “postpranidial glycemia”, in sciencese):

    Good for the brain

    Regular 10almonds readers will know that “what’s good for the blood, is good for the brain” is a very good rule of thumb already, but their highomega-3 content makes them especially so:

    What Omega-3 Fatty Acids Really Do For Us

    Want some?

    We don’t sell them, but you can probably find them in your local supermarket and/or health food store, and if you prefer getting things online, here for your convenience is an example product on Amazon

    Enjoy!

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  • The Brain As A Work-In-Progress

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    And The Brain Goes Marching On!

    In Tuesday’s newsletter, we asked you “when does the human brain stop developing?” and got the above-depicted, below-described, set of responses:

    • About 64% of people said “Never”
    • About 16% of people said “25 years”
    • About 9% of people said “65 years”
    • About 5% of people said “13 years”
    • About 3% of people said “18 years”
    • About 3% of people said “45 years”

    Some thoughts, before we get into the science:

    An alternative wording for the original question was “when does the human brain finish developing”; the meaning is the same but the feeling is slightly different:

    • “When does the human brain stop developing?” focuses attention on the idea of cessation, and will skew responses to later ages
    • When does the human brain finish developing?” focuses on attention on a kind of “is it done yet?” and will skew responses to earlier ages

    Ultimately, since we had to chose one word or another, we picked the shortest one, but it would have been interesting if we could have done an A/B test, and asked half one way, and half the other way!

    Why we picked those ages

    We picked those ages as poll options for reasons people might be drawn to them:

    • 13 years: in English-speaking cultures, an important milestone of entering adolescence (note that the concept of a “teenager” is not precisely universal as most languages do not have “-teen” numbers in the same way; the concept of “adolescent” may thus be tied to other milestones)
    • 18 years: age of legal majority in N. America and many other places
    • 25 years: age popularly believed to be when the brain is finished developing, due to a study that we’ll talk about shortly (we guess that’s why there’s a spike in our results for this, too!)
    • 45 years: age where many midlife hormonal changes occur, and many professionals are considered to have peaked in competence and start looking towards retirement
    • 65 years: age considered “senior” in much of N. America and many other places, as well as the cut-off and/or starting point for a lot of medical research

    Notice, therefore, how a lot of things are coming from places they really shouldn’t. For example, because there are many studies saying “n% of people over 65 get Alzheimer’s” or “n% of people over 65 get age-related cognitive decline”, etc, 65 becomes the age where we start expecting this—because of an arbitrary human choice of where to draw the cut-off for the study enrollment!

    Similarly, we may look at common ages of legal majority, or retirement pensions, and assume “well it must be for a good reason”, and dear reader, those reasons are more often economically motivated than they are biologically reasoned.

    So, what does the science say?

    Our brains are never finished developing: True or False?

    True! If we define “finished developing” as “we cease doing neurogenesis and neuroplasticity is no longer in effect”.

    Glossary:

    • Neurogenesis: the process of creating new brain cells
    • Neuroplasticity: the process of the brain adapting to changes by essentially rebuilding itself to suit our perceived current needs

    We say “perceived” because sometimes neuroplasticity can do very unhelpful things to us (e.g: psychological trauma, or even just bad habits), but on a biological level, it is always doing its best to serve our overall success as an organism.

    For a long time it was thought that we don’t do neurogenesis at all as adults, but this was found to be untrue:

    How To Grow New Brain Cells (At Any Age)

    Summary of conclusions of the above: we’re all growing new brain cells at every age, even if we be in our 80s and with Alzheimer’s disease, but there are things we can do to enhance our neurogenic potential along the way.

    Neuroplasticity will always be somewhat enhanced by neurogenesis (after all, new neurons get given jobs to do), and we reviewed a great book about the marvels of neuroplasticity including in older age:

    The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity – by Dr. Norman Doidge

    Our brains are still developing up to the age of 25: True or False?

    True! And then it keeps on developing after that, too. Now this is abundantly obvious considering what we just talked about, but see what a difference the phrasing makes? Now it makes it sound like it stops at 25, which this statement doesn’t claim at all—it only speaks for the time up to that age.

    A lot of the popular press about “the brain isn’t fully mature until the age of 25” stems from a 2006 study that found:

    ❝For instance, frontal gray matter volume peaks at about age 11.0 years in girls and 12.1 years in boys, whereas temporal gray matter volume peaks at about age at 16.7 years in girls and 16.2 years in boys. The dorsal lateral prefrontal cortex, important for controlling impulses, is among the latest brain regions to mature without reaching adult dimensions until the early 20s.❞

    ~ Dr. Jay Giedd

    Source: Structural Magnetic Resonance Imaging of the Adolescent Brain

    There are several things to note here:

    • The above statement is talking about the physical size of the brain growing
    • Nowhere does he say “and stops developing at 25”

    However… The study only looked at brains up to the age of 25. After that, they stopped looking, because the study was about “the adolescent brain” so there has to be a cut-off somewhere, and that was the cut-off they chose.

    This is the equivalent of saying “it didn’t stop raining until four o’clock” when the reality is that four o’clock is simply when you gave up on checking.

    The study didn’t misrepresent this, by the way, but the popular press did!

    Another 2012 study looked at various metrics of brain development, and found:

    • Synapse overproduction into the teens
    • Cortex pruning into the late 20s
    • Prefrontal pruning into middle age at least (they stopped looking)
    • Myelination beyond middle age (they stopped looking)

    Source: Experience and the developing prefrontal cortexcheck out figure 1, and make sure you’re looking at the human data not the rat data

    So how’s the most recent research looking?

    Here’s a 2022 study that looked at 123,984 brain scans spanning the age range from mid-gestation to 100 postnatal years, and as you can see from its own figure 1… Most (if not all) brain-things keep growing for life, even though most slow down at some point, they don’t stop:

    Brain charts for the human lifespancheck out figure 1; don’t get too excited about the ventricular volume column as that is basically “brain that isn’t being a brain”. Do get excited about the rest, though!

    Want to know how not to get caught out by science being misrepresented by the popular press? Check out:

    How Science News Outlets Can Lie To You (Yes, Even If They Cite Studies!)

    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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