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Painful Sex & Vulvodynia
Pain with sex, and long-standing pain in the vulva, are common and often go unspoken. They can affect intimacy, relationships and wellbeing. James takes these concerns seriously, and offers a thorough assessment and a practical plan to reduce pain.
How can Dr James Brown help?
James provides a careful, gentle assessment to find the cause of your pain. Treatment is tailored and often involves a team, including pelvic floor physiotherapists and psychologists or sex therapists, so that the pain, and the way it affects you, are both addressed.
Painful sex (dyspareunia) is divided by where the pain is felt. Pain at the entrance of the vagina has different causes from pain felt deeper inside.
- Entry pain. Causes include vulvodynia, vaginal dryness from low oestrogen (for example after menopause or while breastfeeding), skin conditions such as lichen sclerosus, infections, and tight or overactive pelvic floor muscles.
- Deep pain. Causes include endometriosis, adenomyosis, fibroids, ovarian cysts, and pelvic floor muscle pain.
More than one cause can be present at the same time.
Vulvodynia is vulval pain that lasts for at least three months and has no clear cause, such as infection or skin disease. It is often described as burning, stinging, rawness or soreness. It may occur only when the area is touched, such as with sex, tampon use or tight clothing (provoked), or it may be present without touch (spontaneous). The most common form is provoked vestibulodynia, with pain at the entrance of the vagina.
Vulvodynia is real, it is common, and it is treatable. It is not caused by anything you have done.
Assessment includes a detailed history, a gentle examination of the vulva and skin, and swabs to rule out infection. A gentle touch test can map where the pain is. The pelvic floor muscles may also be assessed. Further tests, such as an ultrasound or a skin biopsy, are used when needed. You are in control of the examination, and it can be paused or stopped at any time.
Treatment depends on the cause, and usually combines several approaches:
- Treating underlying causes, such as infection, skin conditions, endometriosis, or low oestrogen.
- Topical treatments. Including local anaesthetic, vaginal oestrogen, and compounded creams for nerve-related pain.
- Pelvic floor physiotherapy. To relax and retrain tight muscles, and to guide gradual, comfortable return to intimacy.
- Psychological and sex therapy. To reduce pain-related anxiety and support the relationship.
- Nerve-targeting medications. Used in selected women with persistent pain.
- Procedural options. Injections or surgery are reserved for carefully selected women when other treatments have not helped.
Most women improve with a combined approach, and James will work with you at a pace that feels right.
Have more questions?
Bookings: 1300 722 206