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PAINFUL INTERCOURSE

Intimacy should bring pleasure, not pain. If you experience pain during sexual intercourse, it’s likely a result of atrophic vaginitis, which occurs when the cells of the vagina no longer get the nourishment and hydration they need. Painful intercourse isn’t a condition you just have to endure. Dr. Mary DuPont helps women in the Washington DC metropolitan area, Rockville, Bethesda, Potomac, and Chevy Chase, MD, overcome vaginal dryness using the MonaLisa Touch® and other therapies. Call to make an appointment at Capitol Urogynecology, or to request one online by using the convenient button below.

WHAT IS ATROPHIC VAGINITIS?

Estrogen is the female hormone that helps keep your vaginal wall and vulva feeling moist, supple, and elastic. At a few times in a woman’s life, her estrogen levels drop. These times include:

  • Natural menopause as you age

  • Surgical menopause following a hysterectomy

  • Some cancer treatments

  • During breastfeeding

When your estrogen levels drop, it can result in vaginal dryness and can even cause thinning of the tissue of your vaginal wall. This fragility and lack of lubrication makes you more sensitive to friction, so you feel burning and pain during intercourse.

ARE DRYNESS AND PAIN IN YOUR VAGINA NORMAL DURING MENSTRUATION AND AFTER CHILDBIRTH?

You may have been taught to believe that painful intercourse is just something you have to endure as your body changes, but dryness and pain in your vagina may be resolved relatively easily and without invasive surgery. The MonaLisa Touch Laser stimulates your body to naturally increase collagen production to improve the elasticity and strength of your vaginal wall.

HOW DOES THE MONALISA TOUCH WORK?

After a consultation with Dr. DuPont, schedule the procedure, during which a vaginal probe inserted into your vagina delivers gentle laser energy to the vaginal wall. Research shows that your body responds to the laser by producing more of the skin compounds that improve elasticity and health. When the walls of your vagina are healthier and more robust, intimacy improves and so do your relationships.
You should refrain from sexual activity for two to three days following treatment, but otherwise, you’ll have no restrictions.

HOW DO I KNOW IF I AM A CANDIDATE FOR THE MONALISA TOUCH?

A consultation with Dr. DuPont helps you understand all the details of the MonaLisa Touch treatment so you can determine if it’s right for you. Most postmenopausal women who experience pain during sexual intercourse should benefit.

HOW MANY TREATMENTS WITH MONALISA TOUCH DO I NEED?

You may feel results immediately after your first treatment, but optimal results occur after three sessions scheduled over the course of 18 weeks.
A treatment session lasts just about five minutes and is virtually pain-free. Side effects are uncommon.

DYSPAREUNIA

Dyspareunia (dis-puh-ROO-nee-uh) is the medical term used to describe painful intercourse.  More than 20 million women experience painful sex during their life that may be caused by structural or psychological issues.  It can have a significant adverse impact on a woman’s self-esteem and her relationships with partners.

WHAT ARE THE SYMPTOMS OF DYSPAREUNIA?

  1. Pain upon penetration (entry)

  2. Deep pain from thrusting

  3. Aching, throbbing, or burning pain       

 

WHAT ARE THE CAUSES OF DYSPAREUNIA?

1) Vulvovaginal atrophy (thinning of tissue) due to menopause is the most common cause.  The decreased estrogen and testosterone levels in menopause lead to less lubrication.  Intercourse becomes irritating due to the dryness and the vulvar and vaginal tissue can tear or bleed from the trauma.  Women will often describe their dryness in terms such as “dry as the Sahara Desert” or “sex feels like sandpaper.”  Other conditions can also lead to vulvar and vaginal atrophy due to hormonal changes.  These include medications for breast cancer, infertility, and various birth control methods.  Some of the oral contraceptives resulted in lowering testosterone, which triggered vestibular pain. The vestibule requires both estrogen and testosterone to maintain healthy tissue and blood flow.
2) Pelvic Floor Muscle Dysfunction (Vaginismus): describes spasms in the groups of muscle that surround all the pelvic organs (bladder, urethra, vagina, and rectum).  In addition to painful sex, tightness in these muscles can result in constipation, obstructive urinary symptoms, urinary frequency, and vulvar burning.
3) Interstitial Cystitis (Painful Bladder Syndrome):  a chronic bladder pain condition.  This pain is typically described as pelvic pressure or discomfort.  It often occurs in combination with fibromyalgia and irritable bowel syndrome.  In addition to pelvic pain, women often experience urinary frequency, nocturia (night time frequency), and painful sex.
4) Vulvar pain (vulvodynia):  a pain syndrome that involves the external genitalia and vestibule.  It is typically due to spasm of the pelvic floor muscles (levator ani syndrome) or pudendal nerve neuropathy.  Vulvar pain may also be due to skin diseases, such as lichen sclerosus.
5) Pudendal Neuropathy:  entrapment or injury of the pudendal nerve that supplies innervation to the external genitalia, lower rectum, and perineum.
6) Infection or Skin Disorder: urinary or genital infections can cause painful sex as can any genital skin problem (lichen sclerosus, lichen planus, lichen simplex chronicus).
7) Emotional Factors:  anxiety, depression, stress, and fear of intimacy may play a role.  Women who have had a history of sexual abuse are more prone to suffer from painful intercourse.

 

WHAT TREATMENTS ARE AVAILABLE?

After a thorough history and physical examination is complete, attention is given to determining how best to treat the individual factors.

1) Vulvovaginal atrophy

  • Hormonal replacement: vaginal estrogen in the form of a cream (e.g., Estrace is bioidentical) or a vaginal tablet (Vagifem) or a vaginal ring (Estring).  The vulva will benefit from a combination of estrogen and testosterone cream to restore health.

  • Osphena: an oral medication taken once daily that is a SERM (selective estrogen receptor modulator). It is the only FDA approved, non-estrogen indicated for moderate to severe dyspareunia due to menopause.

  • MonaLisa Touch: in-office laser treatment that is typically painless for vaginal rejuvenation. Collagen production and blood flow increases, thus resulting in more natural lubrication and elasticity.

  • Over-the-counter lubricants and vaginal moisturizers

2) Counseling/Sex Therapy    

  • Vaginal relaxation exercise instruction from a certified women’s physical therapist. Learning more comfortable sex positions may be helpful.

  • Talking to a Sex Therapist may help resolve issues of intimacy and communication with your partner.

3) Pelvic Floor Muscle Therapy

  • Certified women’s physical therapists are trained to perform hands-on release of trigger points (“knots”), deep tissue massage (myofascial release), and joint mobilization. Therapy may be performed internally as well as externally to reach treatment goals. Additionally, the therapist may use other techniques such as biofeedback, cold laser, ultrasound, and electrical stimulation.

4)  Vaginal Dilators

  • Vaginal dilators are rubbery cylinders ranging in size from 3/4 inch to the size of an erect penis. A powerful group of pelvic muscles (pubococcygeus) surround the vagina and anus. These muscles can go into spasm when pain is anticipated with intercourse. Penetration may be completely blocked with severe vaginismus.  Vaginal dilators are used to retrain the pelvic muscles and are most successful when done in conjunction with instructional guidance.  Dilators can be effective tools in eliminating the tightness causing vaginismus and overriding the involuntary contractions of the pelvic floor muscles.  The graduated set of vaginal dilators allows a patient to transition to intercourse as she overcomes the pain associated with insertion.  In addition to their usefulness for vaginismus, dilators are used after menopause to treat narrowing of the vagina.  Dilator therapy can be performed at home and takes 5 to 10 minutes a day.

©2019 by Capitol Urogynecology