Painful sex: how tracking your cycle could fix it
Have you ever heard a man complain of painful sex? Me neither. But, among woman, it is a common problem. The American College of Obstetricians and Gynecologists (ACOG), says nearly three out of four women experience painful sex at some point in their lives. This experience triggers a great deal of frustration, dissatisfaction, and even shame.
Fertility Awareness Based Methods (FABMs) offer a practical way to better diagnose and reduce or eliminate painful sex.
Tessa* had suffered from painful intercourse for almost three years when I met her. Her OBGYN recommended the removal of her Mirena IUD and that she and her husband learn a Fertility Awareness Based Method (FABM) to prevent pregnancy instead. She prescribed use of a topical cream prior to sex and referred her to a pelvic floor physical therapist. Tessa and her husband attended these sessions together so they could get the help together. Through the course of the next six months, sex became less painful—and more enjoyable.
It should go without saying that painful sex is not normal. If you are experiencing it, there is a cause which merits investigation.
What can cause painful sex
Painful sex may include an intense feeling of tightness, a penetration problem (upon entry), burning or aching, deep pain during thrusting, or even throbbing in the hours following intercourse.
Those most likely to experience these issues include women having sex for the first time, women who recently had a baby (even if no severe pelvic floor injury was noted), and perimenopausal women.
Also, women who have endometriosis or ovarian cysts may find sex painful. Intense pain may result from the presence of adhesions from endometriosis (when uterine lining forms outside the uterus) or the swelling or bursting of ovarian cysts
Another possible cause of painful intercourse is pelvic inflammatory disease (PID), an infection and inflammation of the upper reproductive tract. These latter three causes can also contribute to the inability to conceive or maintain a pregnancy.
An example of how tracking your cycles can help
Urologist Joan Meaney M.D. frequently sees patient who experience such pain. Many women’s bladder or urinary track gets irritated a few days before their periods. This irritation is caused by low estrogen levels during that phase of the cycle. Simple solutions include the elimination of acidic foods, using an anti-inflammatory for a few days or taking natural supplements.
The key is to be aware of when it’s coming. “That’s where fertility awareness charting or the tracking of your fertility is key: it allows you to know ahead of time when your periods will be here and to adjust your diet accordingly,” Dr. Meaney advised.
Solving painful sex in three steps
If you are affected by painful sex, consider:
1) Charting your menstrual cycle.
Tessa’s OBGYN recommended learning to chart her cycle because of the helpful data this life skill can reveal. All FABMs have a way to record an act of intercourse in addition to tracking the biomarkers of each day. It is significant whether the pain happens during every act or during a particular part of your cycle. Endometriosis-related intercourse pain characteristically occurs before and during the menstrual flow while ovarian cyst pain would be prevalent mainly in the post-ovulatory phase.
General pelvic pain (outside of intercourse) is worth tracking as well.
2) Chart the type of pain from each time sex was painful and where it was felt (be specific):
Words to describe pain:
3) Discuss the patterns with your health provider.
Make a plan of action for treatment. There are a wide variety of options including food and lifestyle changes, medications, and/or referral to pelvic floor physical therapists for assessment, treatment, and home exercises between appointments (read more about what to expect when seeing a pelvic floor PT for the first time here). In some cases, surgery to resolve the root cause may be indicated. Make a note of improvements on your chart over time to track progress.
Sex shouldn’t and doesn’t have to hurt.
(1) Weschler, Toni, MPH. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health, 20th Anniversary Edition, pg. 284, 391.
*Name changed for privacy