(Painful Sex)

  • More common in women
  • Up to 45% of women have experienced painful intercourse
  • Pain can be felt in the vagina, clitoris and/or labia.


  • Surgery
  • Response to birth control
  • Lack of appropriate lubrication
  • Skin conditions
  • Tight pelvic floor muscles
  • Infections


  • Lubricants, vaginal moisturizers, vaginal dilators
  • Vaginal Estrogen – lack of the sex hormone, estrogen, can decrease the moisture and elasticity of the vagina.
  • Oral Medications – non hormonal.More common

Vaginal Dryness


  • Menopause
  • Diabetes
  • Autoimmune Disorders
  • Medications:
    • Antidepressants
    • Antacid
    • Anticholinergic
    • Anticonvulsants
    • Blood pressure medication
    • Anti-inflammatories
    • Antihistamines
    • Anti-anxiety
    • Decongestants
    • Diuretics
    • Muscle Relaxants
    • Narcotic Analgesic


  • Lubricants and moisturizers
  • Topical estrogen cream, compounded estrogen/testosterone creams
  • Systemic Hormone Replacement – estrogen patches or gels, testosterone creams or pellets and progesterone pills, creams or oils
  • Elimination of medications that may cause the dryness


An involuntary spasm of the vagina with penetration and can occur with intercourse or even with a tampon. Due to vaginal and pelvic floor muscle spasms. Not uncommon but unfortunately it is often not discussed with medical providers.

Primary vaginismus is when the painful penetration has been ongoing over the woman’s lifetime.

 Secondary vaginismus is when a woman previously had pain-free penetration and is now experiencing pain with penetration.


  • Gynecological Trauma
  • Childbirth or surgery
  • Strict sexual upbringing
  • Exposure to Sexually transmitted infection
  • Relationship struggles
  • Fear of sex


  • Pelvic floor physical therapy
    • Vaginal dilators 
    • Biofeedback
    • Trigger point release
  • Sex therapy and counseling


Chronic pain or discomfort around the opening of your vagina (vulva) for which there’s no identifiable cause and which lasts at least three months.


  • Nerve damage to the vulva
  • Pelvic floor muscle dysfunction
  • Sensitivity to certain foods
  • Reaction to an infection
  • Genetic disorders


  • Local anesthetics
  • Topical hormone creams
  • Physical therapy
  • Anti-depressants
  • Trigger point therapy
  • Cognitive Behavioral Therapy


Chronic pain in the vestibule of the vagina  provoked either by any penetration.  The vestibule  is where the external genitalia meets the vagina and includes the Bartholin’s glands and the urethra.

The pain is very individualized and can vary significantly. One person may be able to tolerate penetration for intercourse and another may not be able to even tolerate a tampon. 


  • Topical Anesthetics
  • Vaginal Dilators
  • Pelvic floor Physical Therapy