Aug. 6, 2009 — -- For many women sexual intercourse is an unbearable experience. The women profiled by "20/20" suffered in silence: They did not feel pleasure from sex. Instead, they said they felt excruciating pain.
The unbearable vaginal pain extended beyond sex to everyday activities like walking, and even light contact from wearing blue jeans could be too agonizing to bear. But all the women said what's almost harder than the physical pain is the emotional toll of suffering from such a mysterious condition without a clear diagnosis.
Dr. Andrew Goldstein, who runs the Center for Vulvovaginal Disorders in Washington, D.C., and is a pioneer in the new field of sexual pain disorders, said 20 million American women will suffer from sexual pain disorders at some point in their lives.
So what are the main causes of sex pain? Goldstein said the number one cause is birth control pills, followed by tight pelvic muscles and an overabundance of nerve endings at the opening of the vagina.
1. Did your sexual pain begin while you were taking hormonal contraceptive (birth control pill/patch/vaginal ring) or when you were taking medication for infertility, endometriosis or breast cancer?
2. In addition to your sexual pain, do you have low back pain or urinary symptoms such as frequency, hesitancy, and incomplete emptying, or do you have chronic constipation or rectal fissures?
3. Did your pain begin after an allergic reaction to a topical medication such as a yeast cream?
The topical medications include anesthetics such as lidocaine and capsaicin (which is made from the extract of chili-peppers.) Systemic medications include tricyclic antidepressants such as amitriptyline and anti-seizure medications such as gabapentin. It is also possible to get creams made of the amitriptyline and gabapentin if the side effects are too great when the medications are taken orally.
4. Do you have pain when there is deep thrusting or do you have severely painful menstrual cycles?
5. Do you have vulvar itching severe enough that you wake up at night scratching and you haven't gotten better with medications for a yeast infection?
While some physicians make the diagnosis of these conditions just by their clinical appearance, most physicians, including Goldstein, suggest that a small skin biopsy be used to confirm the diagnosis. It is also importance to have this biopsy before treatment with any medications such as a topical steroid, because they can alter the results of the biopsy.
