If sex hurts, you’ve probably been told to relax, use more lube, or have a glass of wine first. Maybe all three. And if you’re still reading, it probably didn’t work.
Pain with sex is common, it’s real, and it almost always has a cause we can find. At Below The Belt, we figure out what’s actually going on and treat that, instead of telling you to push through.
Painful sex, which doctors call dyspareunia, is pain before, during, or after sex that keeps coming back. It’s one of the most common sexual health problems women have, and it gets more common after menopause.
There are a lot of potential causes, and often more than one at a time. We keep looking until we find yours.
Usually something specific, and often more than one thing:
We start with the details: where the pain is, whether it’s burning, sharp, or aching, when it started, what makes it worse, and whether it happens outside of sex too (tampons, tight jeans, sitting). Your medications and birth control history matter here more than you’d think.
An exam is part of every evaluation for painful sex. It’s how we find the cause. It’s slow, we explain everything as we go, and you can pause or stop at any time.
Treatment depends on the cause, and many women have more than one. We lay out the options, what the evidence says about each, and what we’d recommend, and then we decide together.
There’s no one treatment for painful sex, because there’s no one cause. Depending on what we find, your plan may include:
Most plans combine a few of these. We’ll walk you through what fits, and you make the call.
While tissue heals, it’s often smart to take a break from penetrative sex. That doesn’t mean a break from sex. Plenty of things don’t hurt, and we’re happy to talk about them.
Pain improves gradually, and it’s easy to lose track of how far you’ve come. A simple 0-to-10 pain score after sex helps us see what’s working and adjust.
Go slow, use plenty of the right lubricant, and choose positions where you control depth and pace. Your partner is welcome at a visit if it would help.
Some causes, like menopause-related dryness, don’t go away on their own, so treatment is ongoing. That’s maintenance, not failure.
Topical anesthetics may work right away. Vaginal estrogen and prasterone usually help within a few weeks, with full effect around two to three months. Pelvic floor therapy typically takes a few months of consistent work. Laser therapy is usually a short series of treatments spaced several weeks apart. PRP and nanofat take weeks to months as tissue responds.
If something isn’t helping, we change course rather than wait it out.
Results vary. Your plan and expectations will be based on your own evaluation.
Painful sex rarely stays just painful sex. Pain teaches your body to brace, bracing causes more pain, and before long you’re avoiding sex altogether. The sooner the cycle gets interrupted, the easier it is to break.
It can also point to something bigger. The same hormonal changes that make sex hurt can cause bladder urgency and recurring UTIs, and treating one often helps the other. That’s the idea behind Below The Belt: what happens below the belt is a window into the rest of your health.
We’re a cash-pay clinic, so there are no surprise insurance bills. What you pay depends on what’s causing the pain:
You’ll get a clear quote after your first visit, before anything starts.
Your care is led by Dr. Jake Shank, a board-certified physician and Menopause Society Certified Practitioner. Painful sex is core to that training, not a side topic.
We’ll find the cause, tell you honestly what works, and treat it, from the simplest fix to the most advanced options available.
A moment of discomfort can happen to anyone. Pain that keeps coming back isn’t something to push through. It’s a signal worth getting checked.
Yes. Some pills lower the hormones that keep tissue at the vaginal opening healthy, which can cause burning or pain months or years after starting. Changing the pill and using topical hormones often helps.
Yes. Some form of exam is part of every evaluation for painful sex, because it’s how we find the cause. It’s gentle, we explain it as we go, and you set the pace.
It’s common after menopause, but it isn’t inevitable, and it tends to get worse without treatment. The options are good and safe for most women, including many who’ve been told hormones are off-limits, especially vaginal hormones. We’ll absolutely confer with your primary care doctor or oncologist. More on perimenopause and menopause.
Deep pain can point to endometriosis, fibroids, or ovarian cysts. We’ll evaluate it, and if you need a gynecologist or surgeon, we’ll refer you to someone we trust.
Book a consultation and bring your questions, even the awkward ones. Especially the awkward ones.
