Why does it hurt for some women to have sex?

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Why does it hurt for some women to have sex?

An important aspect of anti-aging therapy includes the maintenance of sexual vitality. What one chooses to do with that vitality is a matter of personal choice, but loss of capability should never be accepted as an inevitable event. Supporting sexual health with bioidentical hormones is an essential tier of the “Anti-aging Pyramid.” We will get to the hormonal part of painful intercourse in a moment, but first an overview of some medical triggers.

It is true that all pain is subjective, and that the line between pain and pleasure can be a matter of individual interpretation. However, there are times when the pain of having sex is just unbearable. This is especially true for women. The medical term for pain with sex, specifically penetrating intercourse, is called “dyspareunia.” This does not refer to the mild discomfort that can occur in the occasional awkward position, or the scenario of inadequate foreplay, but rather consistent repetitive pain that robs sexual activity of its bonding pleasure with your partner.

First, I will share with you some of the pathological triggers for this, then I will focus on the dominant cause of painful intercourse which is a lack of proper hormone support.


Vaginal infections can fall into a category of “bacterial vaginosis.” This is considered to be non-sexually transmitted. Think of it as equivalent of having “strep throat” but only in the vagina. The tissue becomes swollen, and friction becomes painful. This is usually associated with the foul-smelling discharge and is transient. It resolves after treatment.

Herpes can certainly be painful, but it is usually quite obvious when it occurs. The pain is intense, and the duration of symptoms typically lasts approximately one week. The classic vesicular lesions associated with herpes can be inside the vagina and may not be visible. Any type of acute, intense vaginal pain should prompt a visit to your primary care provider.

Vaginal spasm. This is considered a type of psychosomatic reaction which causes the vagina to go into a tight muscular spasm that can be a barrier to intercourse. This is uncommon and the treatment is complex, typically involving a combination of counseling and medical care. However, success can occur with proper management.

“Tipped uterus.” The uterus can have different orientations. In some women it will angle to the front, in others to the back. These positions are usually fixed in an individual, the uterus typically does not flip-flop between positions. In some cases, the uterus can be in a position that instigates pain with deep penetration. This can also occur if fibroids have developed on the uterus in a location where penetration can cause impact discomfort. The first approach to addressing discomfort with deep penetration is to experiment with different positions. If it can be satisfactorily resolved by repositioning, that’s likely all that needs to be done.

Only in very rare circumstances should you proceed with a hysterectomy to resolve this problem. Removal of the uterus can compromise the support needed for ideal bladder control. The uterus is also part of the orgasmic response in many women. At the time of climax, it can undergo pleasurable rhythmic contractions. In some cases, women have reported a decrease in sexual pleasure after removal of the uterus.

Now onto the big issue which is the fading of hormones.

At some point in the lifespan of every woman she will either replace her hormones or suffer the consequence. Some of the inevitable consequences of hormonal depletion are vaginal shrinkage, loss of vaginal elasticity, decrease of vaginal mucus production, and shrinkage of the clitoris. You can well imagine that such a combination of anatomical changes does not bode well for sexual pleasure!

Standard approaches to this dilemma include encouraging women to use lubricants. Although lubricants can be a welcomed adjunct in the bedroom, they don’t solve the inevitable decline that is taking place and can simply be a rest stop on the downward spiral toward vaginal and sexual atrophy.

The ultimate remedy for most causes of painful intercourse is hormone replacement. At a minimum, many doctors, even conventional physicians, will utilize intravaginal estrogen creams for the purpose of rejuvenating the vagina. This is a good and worthwhile step, however for the purposes of anti-aging it does not go far enough.

Proper replacement of the right hormone at the right time by a knowledgeable anti-aging specialist can be life changing. I’ve seen the mistake made of doctors simply giving women a standard prescription of commercial brand estrogens, and artificial progesterones. Although I admire the efforts of the clinicians who are trying to help, a better approach is to personalize the hormones chosen based upon the patient’s age, body type, and baseline hormonal labs.

Quite often testosterone is the first hormone that I recommend for treating vaginal atrophy. Some testosterone will naturally convert into estrogen. In many women this conversion is sufficient to provide all their estrogen needs, and to reverse vaginal atrophy. The thought of taking testosterone is frightening to some women, however once they realize that testosterone is a natural and essential female hormone, and that the only issue to avoid side effects is the amount taken, those fears can be readily addressed, and women can enjoy the benefit of youthful hormones throughout the span of their life.

At some point, based upon progressive fading of hormones and response to treatment, there will inevitably be a need to introduce estrogen, progesterone, and possibly other hormones as well. The philosophy is simple. Address the fundamental causes of aging in order to diminish the consequences of chronologic aging itself. One of the cornerstone elements of that approach is to replace the hormones that the gonads were making as they inevitably decline in their production.

The loss of vaginal mucus, and anatomical integrity often will parallel a drop in libido. These two can certainly overlap since the drop in hormones can affect the fundamental desire to have sex, and the loss of anatomical capacity can be further demotivating. Restoration of a youthful hormone profile by the use of bio-identical therapy can remedy not only the anatomical changes causing painful intercourse but can also rejuvenate desire.

Remember that when evaluating painful intercourse, it is valuable to have an up-to-date internal exam to include a Pap smear if indicated. This step in the process can be well managed by your primary care doctor, even if they are not inclined toward practicing anti-aging medicine. With this medical clearance in place, you can proceed to taking advantage of advanced anti-aging therapies and hormone replacement.

Sometimes women will ask me, at what age should they consider stopping their hormone therapy? I tell them, “When they close the lid!” Anti-aging therapy is not a moment in time, but a sustainable lifestyle. Given a choice, who would voluntarily expose themselves to the ravages of aging when alternatives exist? Painful intercourse in most cases belongs in the category of a preventable consequence of aging.

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