Integrative Medicine Approach to Painful Intercourse in Women: Specialty Testing and Treatment Modalities

In the context of women's health, certain experiences may feel isolating, although they are shared by many. One such occurrence is the experience of pain during sexual intercourse, a condition medically termed dyspareunia. It's reported that approximately 75% of women have encountered such discomfort at some point in their lives. This discomfort can range from a temporary issue to a recurring problem that permeates every aspect of a woman's life, from her intimate relationships to her self-perception. Thankfully, integrative medicine can address the many varied aspects that can cause and contribute to painful intercourse.  

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What is The Definition of Painful Intercourse?

Painful intercourse, medically known as dyspareunia, is characterized as persistent or recurring discomfort that occurs just before, during, or following sexual activity. This discomfort is primarily localized within the genital area. It may manifest externally in areas such as the labia or the vaginal opening, or it may be experienced internally, affecting the cervix, uterus, or lower abdomen. It's worth noting that dyspareunia is not just a fleeting discomfort but rather a consistent issue that may significantly impact an individual's life.

What Causes Painful Intercourse in Women?

There are both physical and psychological factors that can lead to dyspareunia, or painful intercourse. Among the physical causes, vaginal dryness stands out as a frequent issue. Hormonal changes or specific medications can sometimes cause this, and it can often be addressed through measures like relaxation, more extended foreplay, or the use of lubricants.

Another significant physical cause is infections, including those affecting the vaginal or cervical regions. Conditions such as pelvic floor dysfunction, which involves involuntary contractions of the pelvic floor muscles, or other medical conditions like fibroids, endometriosis, and ovarian cysts, can also contribute to this discomfort (2).

Equally important are the psychological factors that can induce painful intercourse. These encompass aspects such as anxiety and past trauma, which can lead to conditions like vaginismus, characterized by involuntary vaginal muscle spasms. Relationship issues stemming from loss of intimacy or stress can similarly play a significant role. It's worth noting that these factors can often interact, where physical pain exacerbates psychological distress and vice versa, necessitating a comprehensive approach to effectively address dyspareunia (2).

Functional Medicine Labs to Test for Root Cause of Painful Intercourse

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Hormone Testing

This test examines key sex hormones such as estrogen, progesterone, and testosterone. Changes in these hormones can cause vaginal dryness and other symptoms that may lead to dyspareunia. In addition, this test looks at markers for stress, such as cortisol. Chronic stress or anxiety can impact the adrenal glands, leading to imbalances in cortisol and other hormones. This can result in various symptoms, including dyspareunia (2).

Inflammatory Testing

Elevated levels of inflammatory marker C-reactive protein (CRP) can indicate systemic inflammation, which may contribute to disorders like endometriosis or pelvic inflammatory disease (PID) and lead to dyspareunia.

Stool Testing

Stool testing can be insightful for addressing dyspareunia, as it helps identify harmful microbes in the gut that may influence the vaginal microbiome. Lifestyle factors, including diet and stress, can impact both gut and vaginal microbiota, potentially leading to vaginal dysbiosis and frequent infections. Therefore, understanding gut microbiome via stool testing can contribute to resolving issues such as painful intercourse.

Thyroid Testing

Hypothyroidism or hyperthyroidism can lead to hormonal imbalances, affecting sexual health and potentially causing dyspareunia. This test examines the levels of thyroid hormones and thyroid-stimulating hormone (TSH) to provide a comprehensive overview of the thyroid’s function.

Additional Labs to Check  

A pelvic ultrasound is useful for identifying physical conditions like ovarian cysts, fibroids, or endometriosis (possibly, as not always seen on ultrasound) that can lead to dyspareunia. Additionally, a Pap smear test can discern cervical cellular changes that may cause discomfort during intercourse, further informing a targeted treatment approach.

Conventional Medical Treatments for Painful Intercourse

Treatment for painful intercourse depends on the specific cause, with options ranging from medication to therapy. Medications could include topical estrogen for postmenopausal women experiencing low estrogen levels and inadequate lubrication or other FDA-approved drugs such as ospemifene and prasterone. Non-medication therapies can include desensitization therapy for vaginal relaxation, counseling, sex therapy to address negative emotional responses and restore intimacy, and cognitive behavioral therapy to change harmful thought patterns and behaviors.

The Integrative Medicine Approach to Painful Intercourse

The integrative medicine approach to painful intercourse includes many different facets, such as pelvic floor physical therapy, natural remedies, psychological approaches, and lifestyle strategies.

Referral To a Pelvic Floor Physical Therapist

For many women, open communication with your partner about what feels good and what doesn't, as well as not rushing penetration until full arousal, can aid in mitigating discomfort during sexual activity. In terms of therapeutic approaches, releasing myofascial trigger points in the pelvic floor can offer effective relief from chronic pelvic pain, a common source of painful intercourse.

If neither of these appraoches provide relief, a referral to a pelvic floor physical therapist can be a pivotal step toward alleviating discomfort. The pelvic floor is an interconnected network of muscles, tissues, and nerves that- if dysfunctional- can contribute to pain during intercourse. A trained physical therapist can help address these issues through various techniques, including pelvic floor exercises, manual therapy, biofeedback, and education about pain management strategies. By strengthening and relaxing the muscles of the pelvic floor, improved control and reduction of discomfort during sexual activity can often be achieved.

Herbal and Natural Remedies For Vaginal Dryness and Pain Relief

Natural oils, such as grape seed, olive, sunflower, or coconut, can serve as safe home remedies for vaginal dryness, acting as external lubricants before intercourse. However, it is essential to note that oil-based lubricants can impair the functionality of condoms. Engaging in regular sexual stimulation and extended foreplay can foster natural lubrication since vaginal moisture is closely tied to arousal levels. Additionally, several herbal supplements, including curcumin, pine bark extract, chamomile, peppermint, Vitex, and Ashwagandha, might play a role in managing inflammation or hormonal imbalances that can contribute to sexual discomfort. However, the effectiveness of these supplements is largely contingent upon the individual's specific cause of pain.

Acupuncture and Acupressure for Pain Management

Acupuncture, an ancient Chinese practice, effectively manages pain by stimulating nerves in muscles, signaling the central nervous system, and triggering the release of endorphins. In addition to acupuncture, cupping, and gua sha treatments may be administered to reduce inflammation associated with chronic pain. Cupping therapy creates suction on the skin to release the fascia from the muscle layer, with numerous studies indicating positive results for pain management. Auricular acupuncture, where tiny needles or ear seeds are placed on specific ear points, is another useful practice. Even needle-free acupuncture has shown efficacy comparable to conventional needle acupuncture, making it an ideal choice for those afraid of needles. Acupressure, a kind of massage focusing on acupoints, aids in muscle relaxation and blood flow improvement. By applying pressure to specific acupoints, such as the LI-4 point, which is found on the hand, one can alleviate general pain. Both acupuncture and acupressure offer non-invasive, integrative options for pain management.

Psychological Approaches to Addressing Painful Intercourse

Addressing psychological factors is an important part of managing painful intercourse, as emotions are deeply linked with sexual activity. Anxiety, depression, self-image concerns, intimacy fears, and relationship problems can lower arousal levels and induce pain. Stress, too, can result in tightened pelvic muscles, contributing to discomfort during sex. For those with a history of sexual abuse, it can also be a contributing factor. Cognitive-behavioral therapy (CBT) is efficacious in managing anxiety and negative thought patterns associated with pain during intercourse. Counseling and psychotherapy, including trauma-informed care and long-term intensive therapy, help address past trauma and relationship issues. Stress management, through integrative nutrition and botanical medicine, can also alleviate dyspareunia. Yoga and other practices help modulate cortisol levels, which manage stress responses. Eye movement and desensitization and reprocessing (EMDR) therapy with behavioral therapy has shown positive results as a stress management technique. Hence, comprehensive and integrative approaches are a key part of addressing the psychological aspects of painful intercourse.

Integrative Medicine Lifestyle Strategies for Long-Term Relief

Self-care interventions, such as seeking health advice for sexual health concerns, can support sexual health and help manage dyspareunia. Physical health maintenance, participating in pleasurable activities, and avoiding harmful substances contribute to a balanced self-care routine. Communication plays a significant role in maintaining sexual health, with open discussions about boundaries, preferences, and desires enhancing comfort and satisfaction. Verbal and non-verbal cues allow partners to express desire and pleasure effectively. Intimacy in relationships can be nurtured through sharing personal experiences with trusted individuals. Regular contact with health professionals ensures ongoing support and management of physical or psychological concerns. When distress arises, it's worth noting that seeking professional help is a good choice. These strategies, collectively, significantly enhance sexual health and overall well-being in the context of dyspareunia.

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Summary

In summary, the comprehensive approach of integrative medicine towards dyspareunia is a testament to its commitment to understanding and addressing women's health issues. Rather than treating symptoms in isolation, this approach attempts to identify and tackle the root causes, offering a more sustainable and holistic relief to women experiencing painful intercourse. It also underscores the necessity for open conversations and proactive measures in addressing such pervasive yet underreported issues. As research and understanding of dyspareunia continue to evolve, there is hope is for every woman to enjoy a fulfilling, pain-free sex life.