It’s not an easy subject to discuss.
But it’s something that deserves attention because it affects many women, and as a result, many couples. Some women experience pain during sex so excruciating that they are unable to enjoy a happy and healthy sex life.
According to Dr. Deborah Coady, a board-certified obstetrician-gynecologist specializing in this arena and the co-author of Healing Painful Sex, there are a number of causes for this type of severe pain.
The most common causes are surface problems as well as pelvic floor muscle and connective tissue abnormalities, including tension, spasms, tight bands, and shortening; pelvic nerve irritation, injury, or compression; organ pain like endometriosis or painful bladder syndrome; and orthopedic abnormalities.
“When abnormally short or tense muscles cause painful sex, placing Botox into these particular muscles ... allows them to normalize in length and tone. By doing this, muscles become more comfortable to pressure, and as a result, for sexual activity and intercourse.”- Dr. Deborah Coady
It sounds daunting, I know. But the good news is that most women can be helped once they are diagnosed accurately and completely, according to Coady. Remedies include trigger point injections, nerve blocks, oral medications, pelvic floor physical therapy and Botox. That’s right, you heard me correctly ― Botox.
Botox, or botulinum toxin A, is typically used for cosmetic reasons – it can tighten the forehead and eye area to temporarily get rid of wrinkles – but doctors are finding it can help relieve many other health problems.
Botox is “a medication that relaxes and releases muscles into which it is injected,” Coady said. “When abnormally short or tense muscles cause painful sex, placing Botox into these particular muscles around (the perineal area) and in the pelvic floor allows them to normalize in length and tone. By doing this, muscles become more comfortable to pressure, and as a result, for sexual activity and intercourse.”
Perhaps the best news is that when used correctly, Botox is extremely safe.
“However, Botox placed into the wrong or inappropriate muscle can cause that muscle to not function well,” Coady warned.
Like with any medical procedure, Coady said it is important to find a physician who is highly experienced in this procedure.
“If the injections are not done accurately, they will not be beneficial,” she added.
The idea of having injections in such a sensitive area may have some women wondering if the cure is worse than the disease.
Coady said not to worry – with careful preparation, the pain can be minimized with topical numbing agents and medications to make the patient feel relaxed.
Some patients prefer to be put under general anesthesia for the procedure, and some doctors may oblige, but Coady said she is not one of them.
Because the Botox needs to be placed expertly into these sensitive areas that are actually causing the dyspareunia, Coady said an awake patient can help guide the procedure.
“Also, if general anesthesia is used, these muscles become totally relaxed, and I cannot feel and identify them accurately,” she added.
Relief from Botox typically lasts about three months, and it can take up to two or three weeks for the full effects to take place. In order to provide patients with a long-term solution, pelvic floor physical therapy is imperative.
“The muscles that are newly released, lengthened and relaxed are surrounded by connective tissue, which may still be shortened and inelastic,” Coady said. “Physical therapy is necessary to normalize the connective tissue to accomplish long-term balance and strength.”
Botox is just one of many ways to treat sexual pain, but in order to treat the problem, women have to talk to a doctor – the right doctor – about it.
Coady said many women feel too uncomfortable discussing the topic with their doctors, and all too often, doctors can be just as uncomfortable or uninformed. This should not stop you from getting the care you need.
“There are accurate diagnoses and excellent treatments for the conditions causing painful sex,” Coady said, adding that a woman’s partner can be beneficial in supporting her.