Health Column
September 8, 2010
MEDIA CONTACT: Joyce Brennan
Public Information Officer
Southcoast Health System
Phone: 508-961-5270
Fax: 508-961-5876
Pager: 508-387-9605
brennanj@southcoast.org
www.southcoast.org/news/releases/
Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women, Inc., Mattapoisett, New Bedford and Dartmouth
Dr. Pope practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals Group.
He can be reached at 508-999-6245
This week’s topic is a very personal, yet common topic that occurs on a daily basis in the
gynecology office. Let’s begin with an excerpt from The Female Patient ®, Vaginismus: A True
Disorder?
Tina’s legs shake as she places them in the stirrups. She has avoided gynecologic examinations
since her first one, which she discontinued because the pain was unbearable. But her fear of
what is wrong with her now outweighs her fear of this exam. She has been with her partner for
one year, and they have never been able to have sex; her vagina feels blocked and the pain
seems to worsen every time they try.
What you should know about pain during intercourse.
Sexual activity is normally a pleasurable and natural part of life for many women. Some women,
however, experience pain during intercourse. Many women, in fact, abstain from frequent
intercourse due to this discomfort. There are many conditions that may be the source of pain. If
you have discomfort that interferes with intercourse, discuss your symptoms with your
gynecologist to get treatment.
What causes pain during intercourse?
There are a number of conditions that may result in pain during intercourse. The pain can be
located on the external genitals (such as superficial pain on the vulva, at the vaginal opening),
inside the vagina/pelvis (deep pain in the abdominal region), or both. Some potential causes are
vaginal or yeast infections, sexually transmitted infections, skin conditions, lack of sexual arousal
and lubrication during sexual activity, hormonal changes, genetic factors, and vaginismus, as well
as other problems. It is important to note, that many times, there isn’t an exact reason for painful
intercourse, even after a complete evaluation. This can be frustrating, but yet relieving to know
that there is not anything medically concerning.
Pain during intercourse may also be associated with certain chronic conditions such as
endometriosis, irritable bowel syndrome, interstitial cystitis (painful bladder syndrome), and
pelvic inflammatory disease. It is the most common symptom of “vulvodynia”.
What is vulvodynia?
Vulvodynia affects women of all age groups, beginning as early as adolescence. According to an
National Institute of Health funded Harvard Medical School (Stewart, EG. JAMWA, 2003),
almost 16 percent of women in the U.S. suffer from vulvodynia at some point during their lives,
with more than 90 percent report ongoing pain for many years. Approximately six million women
currently suffer from vulvodynia. The incidence of symptom onset is highest bet ween the ages of
18 and 25, and lowest after age 35.Once considered a condition that affects primarily Caucasian
women, several recent studies have shown that African American and Hispanic women
are equally likely to develop vulvodynia.
Living with vulvodynia imposes serious limitations on a woman's ability to engage in normal
daily activities. In many cases, the pain is so severe and unremitting that it forces women to
resign from career positions, abstain completely from sexual relations and limit many physical
activities, often destroying a woman's self-image. In addition, because genital disorders are not
openly discussed, women with vulvodynia experience isolation and hopelessness.
According to an National Institute of Health study funded by Robert Wood Johnson Medical
School (Arnold LD. AJOG, 2007):
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75 percent of women with vulvodynia feel “out of control” of their bodies
60 percent report that it compromises their ability to enjoy life
60 percent cannot have sexual intercourse because of the pain.
Vulvodynia is superficial pain or discomfort that occurs in the absence of physical findings (that
is, there is no infection or other physical problem to directly explain why pain is present). The
pain can be provoked by pressure to the area (such as during sexual intercourse or tampon
insertion) or it can be unprovoked (when there is no external trigger for the pain; it occurs
spontaneously). The pain can also be localized to a certain area, like the vaginal opening, or
generalized to the entire vulvar region. Unfortunately, because vulvodynia occurs in the absence
of physical findings, some women are incorrectly told by a clinician that there is no cause for
their pain, as no infection is present to explain their symptoms. This might lead women to believe
their pain is not legitimate or that it is all in their head. Vulvodynia is a real pain condition,
however, with many women across the life cycle reporting this condition.
What is vaginismus?
Women with vaginismus experience great difficulty with vaginal penetration, such as during
gynecologic exams, tampon insertion, or sexual intercourse. In some cases, vaginal penetration
has never been possible. Women with this condition tend to regularly experience pain during
attempts at vaginal penetration and have tension in the pelvic floor muscles (those that control
voiding of the bladder and bowels). Due to this difficulty, women with vaginismus experience a
great deal of fear and anxiety about vaginal penetration, which may lead them to avoid such
situations.
Is there treatment for my pain?
A patient with symptoms of vaginismus, such as the person mentioned in The Female Patient ®
excerpt at the beginning of this article, must be approached with patience, understanding, and a
gentle manner, as a negative and/or painful gynecologic examination experience may worsen the
patient’s distress. The clinician and patient may need to meet several times beforehand. Your
physician will discuss your symptoms with you and will perform a pelvic exam. Treatment
options may include medications, biofeedback therapy, anesthetic ointment, behavioral exercises,
and in some cases, and rarely, surgery. Some lifestyle remedies may be offered to relieve pain
and itching. The treatment depends on the cause of the discomfort. If the diagnosis is not
established, the treatment will be incorrect.
Where can I find more information on pain during intercourse?
Your clinician is a trusted and valuable source of information. In addition, some helpful websites
are available from the National Vulvodynia Association (www.nva.org), the International Society
for the Study of Vulvovaginal Disease (www.issvd.org), and www.vulvodynia.com.
Have a Women’s Health topic you would like covered? Dr. Pope is happy to answer your
questions or write a column on a topic you choose. Please send Women’s Health topic requests to
Joyce Brennan at brennanj@southcoast.org.
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