WE all do it – push away a niggling pain, smear of blood or embarassing fluid during intimacy, terrified or “ruining the mood”.
But medical experts have issued a stark warning that tolerating a painful sex life isn’t just a threat to your relationships, but a gamble with your health.
Unexpected symptoms can threaten to derail a moment of intimacy Credit: Getty
People shouldn’t be embarrassed about getting symptoms checked out Credit: Getty
“Sex should not be painful – you do not need to lie back and think of England!” says GP and author Dr Philippa Kaye
You also shouldn’t be embarrassed about getting symptoms checked out. An infection, chronic condition or even cancer, in rare cases, are best treated as early as possible.
“Many women experience symptoms they feel unsure about or dismiss as normal,” says Dr Nikki Ramskill, founder of The Female Health Doctor Clinic.
“An early assessment not only provides reassurance, but also helps prevent more serious issues developing.”
Love hurts
Is sex more pain than pleasure? That’s not normal, experts say Credit: Getty
Ever said “ooo-ouch!” instead of “ooo-ahhhh”?
“Studies suggest the majority of women experience dyspareunia, the medical term for pain during sex, at some point in their life,” says Dr Kaye.
“Yet it often goes unreported, because people assume it’s normal.”
The location and intensity of the pain give clues about the potential cause, which is often treatable.
Superficial soreness in the opening of the vagina can be caused by vaginal dryness – commonly linked to breastfeeding, hormonal contraception, perimenopause or menopause, but it can happen at any age.
Burning, stinging pain from penetration could indicate vaginismus, which is when pelvic floor muscles spasm involuntarily, making penetration difficult or impossible.
“It can occur after a painful sexual experience, childbirth, infection, trauma or a period of anxiety,” Dr Kaye says.
“Once pain has occurred with penetration, the body and mind become primed to expect it again, causing the muscles to reflexively contract.”
Deep pain in the pelvis during sex could be endometriosis, where tissue similar to the womb lining grows outside it, or pelvic inflammatory disease, uterine fibroids, or ovarian cysts.
TREAT IT: “Using a good-quality, water-based lubricant during sex can make an immediate difference to vaginal dryness,” says Dr Kaye
Try brands such as Yes or Sylk.
“If dryness is linked to breastfeeding, menopause or perimenopause, vaginal oestrogen is extremely helpful,” she adds.
Speak to a GP about this. “Vaginismus can be treated with pelvic floor physiotherapy involving guided exercises and the gradual use of vaginal dilators – smooth, tapered dilators of increasing sizes to help the muscles relax,” says Dr Kaye.
Psychological support can address anxiety and negative associations with sex, too.
“With conditions such as endometriosis, sex positions with more shallow penetration can be less painful,” says GP Dr Stephanie de Giorgio.
Red alert
Have you noticed blood on the sheets, toilet paper or in your knickers after sex?
This could be the result of small tears in the vaginal lining from dryness, non-cancerous growths in the cervix called polyps, or cervical ectropion, where cells normally lining the cervix come to the surface, causing bleeding.
It’s more common during pregnancy or if you’re on the Pill.
“Importantly, post-coital bleeding can occasionally be a sign of cervical cancer or pre-cancerous changes,” says Dr Kaye, who explains that you should always see a GP if you notice blood after sex.
Dr Ellie Cannon, author of The Little Book Of HRT, adds: “Most women who bleed after sex will not have cervical cancer, but it’s still a very important thing for people to know.
“Any of the gynaecological cancers – cervical, womb or vaginal – can all cause bleeding after sex.”
Something fishy
Something smell off? If it’s noticeably different, your vagina may be unhappy Credit: Alamy
A whiff of odour from down there may make you feel self-conscious during a romp.
“You won’t smell like a bunch of roses because, well, your vagina is not a bunch of roses,” says Dr Kaye.
“However, a noticeable change in smell – particularly one that is fishy, sour or simply ‘different’ – is worth getting checked out.”
It could be bacterial vaginosis (BV), a disruption to the natural bacteria in the vagina, which causes thin, watery, grey-white discharge with a distinctly fishy smell that’s often most noticeable after sex or during a period.
“Trichomoniasis, an STI from a tiny parasite, can cause an unpleasant-smelling vaginal discharge, which can be yellow-green and frothy, as well as itching, soreness, and pain when urinating,” Dr Kaye adds.
TREAT IT: Skip the home remedies for BV and head to the doctor or sexual health clinic for antibiotics, advises Dr de Giorgio.
“There isn’t a huge amount of evidence that pharmacy and supermarket BV treatments are very effective,” she adds.
Only ever use water and plain, fragrance-free soap to gently clean the vulva to prevent disruption to the natural balance of flora in the vagina – a cause of BV.
What are the symptoms of thrush and BV?
Symptoms of thrush in women include:
White vaginal discharge (often like cottage cheese), which does not usually smell
Itching and irritation around the vulva and vagina
Soreness and stinging during sex or when you pee
Symptoms of thrush in men include:
Irritation, burning and redness around the head of the penis and under the foreskin
A white discharge (like cottage cheese)
An unpleasant smell
Difficulty pulling back the foreskin
Symptoms of bacterial vaginosis include:
An unusual vaginal discharge that has a strong fishy smell, particularly after sex
A change to the colour and consistency of your discharge, such as becoming greyish-white and thin and watery
Half of women with bacterial vaginosis do not have any symptoms.
Bacterial vaginosis does not usually cause any soreness or itching.
Source: NHS
Rash decision
It’s easy to forget that genitals also have skin that may suffer from conditions such as eczema or psoriasis.
Friction can aggravate sensitive skin, too.
Most women have had thrush at some point – itchiness with thick, white, cottage-cheese-like discharge – but look out for a lesser-known condition that tends to strike women over 50.
“Lichen sclerosus is a chronic skin condition that causes white, patchy and sometimes fragile skin on the vulva and around the anus,” says Dr Kaye.
“Symptoms include intense itching, burning and pain during sex.”
STIs, such as herpes, may also cause itching and tingling, followed by clusters of small, painful blisters around the genitals.
TREAT IT: If over-the-counter thrush treatments don’t work, see your GP.
As with BV, thrush can be prevented by avoiding washing inside the vagina, so showers instead of bubble baths may help.
See a GP about symptoms of herpes or lichen sclerosus. “It is important to get lichen sclerosus diagnosed and monitored, because it carries a small but increased risk of vulval cancer,” Dr Kaye says.
“Around four in 100 women with lichen sclerosus develop this over their lifetime.”
