When love hurts

A patient experiencing menopause confided in Dr. Michael Feloney that she had lost interest in sex and her marriage was in jeopardy.

“I found that she had a normal desire,” said the Omaha urogynecologist and urologist. “Her real problem was that sex hurt her, and she was ignoring the pain. If you have pain with sex, you're not going to have a sex drive.”

Painful sexual intercourse (dyspareunia) has many causes, ranging from ovarian cysts to urinary tract infections. Hemorrhoids, sexually transmitted infections, lack of lubrication, vaginal infections, scarring from surgery after childbirth and allergies to products such as soap are among other possible causes of painful sex.

Another condition that causes pain is provoked vestibulodynia, also known as vulvar vestibulitis syndrome, an inflammation of the glands and tissue of the internal vulva.

“The cause is unknown, but there are known factors that can aggravate or trigger flareups, such as certain soaps or a diet high in oxalate, found in some foods and drink,” said Feloney, who treats female sexual dysfunction at the University of Nebraska Medical Center.

A disorder called high tone pelvic floor dysfunction is another cause of pain. Inside the bony, bowl-like pelvis are muscles considered the “floor” of the pelvis. Like other muscle groups, they can become hypertonic or “spastic.”

Symptoms of high tone pelvic floor dysfunction include painful intercourse, back or hip pain, and pelvic pain or discomfort. The condition can be caused by trauma from a fall, vehicle accident, childbirth or repeated trauma from activities, such as running or bicycling. Sometimes the cause is unknown. Primary treatment is referral to a physical therapist trained in treating the disorder.

Feloney uses ultrasound technology when treating pain caused by high tone pelvic floor dysfunction. Ultrasound directs the injection of medication that relaxes the muscles and allows more effective physical therapy. — Judy Horan