The medical conditions that can turn a woman’s sex life to AGONY
Many suffer in silence but could be helped by very simple treatments
Angela lyons still very much l oved her husband of 44 years — but there was one thing missing in their relationship: a sex life. When her husband finally turned to her after years of this and lamented: ‘I want my wife back,’ angela knew the time had come to seek help.
‘That was the moment I knew I couldn’t avoid the problem any longer,’ recalls angela, 66, a retired administrator and mother of two.
angela suffers from dyspareunia — pain during sex. she had the condition for six years from the age of 57, before finally plucking up the courage to seek help.
It’s a surprisingly common problem. one study published in the journal Menopause in 2008, based on the results of an anonymous questionnaire, reported that 40 per cent of women suffer from it.
another study, published, in the scandinavian Journal of Public Health, found it affected around 10 per cent of women. Determining the true number who experience pain during sex is difficult, as many are simply too embarrassed to seek help.
‘The crucial thing to remember here is that there is lots that can be done to pinpoint what is causing the problem,’ says Dr sarah Jarvis, a london-based gP. ‘But women need to start off by going to see their gP, and that can be hard to do if you are feeling embarrassed about the whole issue.’
she says she has seen relationships break down due to painful sex — yet often the cause can be easily identified.
‘I can take swabs, check for infections or inflammation, investigate if their contraceptive coil has slipped out of place, or do ultrasounds and ultimately refer on to the appropriate specialist if I think it necessary.’
There can be a variety of causes. ‘Illness or infection, physical or psychological, or a combination of several factors can trigger it,’ says Kate lough, pelvic-floor physiotherapist at the Western Infirmary in glasgow.
one of the most common causes is menopausal changes. Falling levels of the female hormone oestrogen, which normally keeps tissues moist and healthy, can cause vaginal dryness.
‘also, post-menopause, the vagina is not as elastic and expandable as it was,’ adds Kate lough. This is because the drop in oestrogen affects collagen, the protein that helps keep tissues healthy. The physical problems can be compounded by the effect that falling hormones have on sex drive, mood and energy.
The physical discomfort can often be helped with hormone replacement therapy (HRT), oestrogen cream or pessary. The advantage of the cream or pessary is that it works exactly where it’s needed, increasing blood flow, improving lubrication and boosting tissues, and has less risk of side-effects.
Gel or cream can be used twice a week and is left in overnight. another option is a vaginal moisturiser. These are better than Ky Jelly, explains Dr Heather Currie, a consultant gynaecologist and managing director of the website Menopausematters.co.uk.
This is because Ky Jelly is a short-acting product designed for medical use, while vaginal moisturisers last longer and are better suited, she says, for sexual activity.
yet while all these treatments could make a difference, Ms lough says many older women f eel almost ashamed of their issues.
‘some women feel embarrassed about being sexually active into their 70s and don’t ask for help if there’s a problem,’ she explains.
This was the case for angela lyons. But after finally plucking up the courage to go to her doctor, she was prescribed pessaries and oestrogen cream, which have led to a great improvement. she was amazed there could be ‘ such a simple solution’.
There are many other causes of painful sex, however. some women may experience problems as a result of scar tissue from a tear in the perineum made in childbirth from an episiotomy (where an incision is made in the perineum to help deliver a baby).
an estimated 90 per cent of women experience a tear during their first delivery. sometimes any discomfort or pain may not become apparent until years later, for instance when the woman goes through the menopause and hormonal changes start to affect the tissues in the area.
Problems with scar tissue can usually be sorted out by a small procedure — known as Fenton’s procedure — where the scar tissue is removed. This can be done as a day case, often under local anaesthetic, and the woman recovers very quickly, explains Pat o’Brien, a consultant gynaecologist at University College london Hospitals and a spokesperson for the Royal College of obstetricians and gynaecologists. another cause of pain during s ex is endometriosis, when womb-like tissue grows in the ovaries, fallopian tubes or cervix. Patches of endometriosis can vary in size from a pinhead to large clumps. Women with this condition may feel pain deep inside, which may last a few hours after sex. The pain, which is in the lower tummy and pelvic area, can be constant, not just around the time
1 10 in Proportion of men and women who are worried about their sex lives
of intercourse, and may be particularly intense on the days just before and during a period.
Fibroids — growths of muscle and tissue in the womb — can also cause problems. While fibroids themselves are not painful, they can make the womb quite ‘bulky’, which in t urn can l ead to discomfort during intercourse.
Constipation or a bout of irritable bowel syndrome (IBs) can also have an effect.
More everyday triggers include general irritation or allergy caused by soaps and shampoo.
Mr o’Brien advises against using intimate feminine hygiene products. ‘The vagina needs a certain amount of good bacteria to be able to do its job properly. There is no need to buy special products — a sensible personal hygiene routine is all that is needed.’ For June edwards, 57, a retired administrator from glasgow, the solution was not straightforward. she was diagnosed with lichen sclerosus, a skin disorder that causes small, itchy or sore white spots on the genitals.
over time, these spots can become larger and come together to create large, white plaques. They can make sex feel painful
Most common in women over 50, its cause is unknown, although it is not contagious. one in 1,000 women is affected, but it’s believed milder cases go untreated as women don’t seek help or believe it to be thrush.
But unlike thrush, lichen sclerosus doesn’t cause discharge, and over-the-counter medication for thrush won’t help it.
June suffered with lichen sclerosis for eight years from the age of 49, during which time it got worse. she waited seven years until she went to hergP. There, she was referred on to a gynaecologist, who prescribed steroid cream to reduce inflammation.
she was also referred to Kate lough for help tackling the pain.
some causes may be more psychological than physical — vaginismus, a condition where muscles at the vaginal entrance shut tightly, can make sex painful or impossible.
Kate lough says: ‘The reasons for this condition can be physical or psychological — there may be a background history of abuse, or trauma from childbirth.
‘a vicious cycle may be set up, with pain leading to nervousness about intercourse, which in turn leads to further tension and pain.’
Dr Jarvis urges anyone who experiences pain with sex to seek help, as in almost every case ‘things can be done to improve the situation’.
names have been changed