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Your (Very Personal) Health at 20, 30, 40, 50

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Painful Intercourse

Pain during sex can be felt both inside the vagina and externally on the labia, clitoris, and vaginal opening — and it can happen at any age. The causes are various, so it may take some investigation to find the culprit. For instance, antihistamines can cause vaginal dryness and pain, so if you're taking them, ask your doctor about alternatives. Dryness may also be related to perimenopause or insufficient foreplay, so try using a lubricant. Other conditions such as fibroids can also cause pain during sex, so see your doctor to identify any underlying concerns.

Sometimes the pain just stops by itself, says Michelle Luthringshausen, M.D., an assistant professor of ob/gyn at Northwestern University. But chronic vulval pain may signal vulvodynia, a condition that affects one in six women, estimates the National Vulvodynia Association (NVA). Experts don't know what causes vulvodynia, and while there is no cure, symptoms can be managed with topical numbing agents, anticonvulsants, and/or SSNRIs (antidepressants also used to combat pain disorders), says Christin Veasley, director of research for the NVA. Women in constant pain may benefit from a type of physical therapy that includes massage of the muscles surrounding the vagina and exercises similar to Kegels, which involve contracting and releasing the muscles used to stop urine flow. To find a therapist who specializes in women's health, go to the American Physical Therapy Association Website at apta.org/consumer.

If you can't pinpoint a physical cause, a certified sex therapist may help. "Intercourse should not be painful," says Beverly Whipple, Ph.D., a coauthor of The G Spot: And Other Discoveries About Human Sexuality. "If it is, you have to explore what's happening, both physically and psychologically. Are you aware of what you find pleasurable? Are you communicating it to your partner? A sex therapist can guide you in finding the answers." To find one in your area, go to the American Association of Sexuality Educators, Counselors and Therapists Website at aasect.org.

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