Tag: sex therapist

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Maybe Your Dead Bedroom Marriage Needs a Hit of Ketamine

— Psychedelic Sex Therapy 101

I asked a doctor who’s an expert in the treatment

By Sarah Stiefvater

Whether through the iconic Dr. Ruth Westheimer (RIP) or the Netflix hit Sex Education, you’ve probably heard of sex therapy. But have you heard of psychedelic sex therapy? It’s basically traditional sex therapy that integrates the use of psychedelics to address sexual issues. I reached out to Dr. Steven Radowitz, MD, the Chief Medical Officer and Co-Founder of the psychedelic wellness clinic Nushama, to learn more.

Meet the Expert

Dr. Steven Radowitz, MD, is the Chief Medical Officer and Co-Founder of the psychedelic wellness clinic Nushama. Dr. Radowitz has a wealth of experience seeing the effects trauma can have on our physical health firsthand. He joined Nushama to oversee and develop treatment modalities, believing psychedelics are the future of mental wellness as current solutions treat symptoms, not underlying issues. Dr. Radowitz also runs the primary care program at Goldman Sachs and has practiced internal medicine and primary care since 1998. He completed his MD at Chicago Medical School, worked at St. Vincent’s in general medicine and HIV/AIDS units and was Medical Director of the inpatient alcohol and opiate detox and treatment unit.

What Is Psychedelic Sex Therapy?

In psychedelic couples therapy, both members of a couple, with the help of a sex therapist, work through the emotional blockages that have been getting in the way of healthy intimacy.

Many relationships get stale over time, thanks to life stressors like work, kids and money, which start to make their way into the bedroom. Sex therapy in a committed relationship can help maintain a deep physical and emotional connection and bond between a couple,. Psychedelic sex therapy takes it to the next level: “Psychedelic experiences can help realign our consciousness and focus away from these mounting worries, help process past difficult life situations and in doing so, regain a greater sense of connection to those that we love,” Dr. Radowitz tells me.

He adds, “Psychedelic sex therapy integrates the use of psychedelics with traditional sex therapy techniques to address sexual issues, intimacy challenges and trauma. This approach combines the psychological healing effects of substances like MDMA, psilocybin or ketamine with therapy aimed at improving sexual well-being, intimacy and relationships.” He adds that currently, on a federal level, ketamine is the only legal psychedelic available to use in a clinical setting in the United States. MDMA and/or psilocybin are legally available for clinical use in a number of other countries such as Australia (MDMA, psilocybin), Jamaica (psilocybin) and the Netherlands (psilocybin truffles).

How Does Psychedelic Sex Therapy Differ from Traditional Sex Therapy?

Per Dr. Radowitz, here’s how it differs from traditional sex therapy:

  • Use of Psychedelics: Psychedelic sex therapy involves the controlled use of substances that alter consciousness, with the intention of accessing deeper emotional states, healing trauma and fostering openness in therapy. Dr. Radowitz says, “Traditional sex therapy typically relies on talking, behavioral interventions and psychological techniques without the use of psychoactive substances.”
  • Access to the Subconscious: He explains that psychedelics allow access to unconscious emotions and memories that may be difficult to reach in traditional therapy, which can help individuals or couples explore and resolve deep-seated issues related to sexuality (like trauma, repression or body image issues), which might be harder to address in a non-altered state.
  • Increased Emotional Openness: “Substances like MDMA can reduce fear and increase feelings of trust, safety and emotional intimacy,” Dr. Radowitz tells me. “This can enhance the therapeutic process by helping people feel more comfortable discussing sensitive issues or facing difficult emotions. Traditional sex therapy may take longer to achieve this level of openness and vulnerability.”
  • Somatic Awareness: Psychedelics often heighten body awareness, which can help address physical or sensory aspects of sexuality. “This can facilitate the exploration of body sensations, desires and boundaries, which may be more difficult to achieve through talk-based therapy alone.”
  • Enhanced Empathy and Connection: Another benefit of psychedelic experiences: they can foster empathy, which is particularly beneficial in couples therapy. Dr. Radowitz notes that the altered state can help partners connect on a deeper emotional and spiritual level, potentially leading to breakthroughs in communication and intimacy that traditional therapy may struggle to achieve as quickly.
  • Therapist’s Role: “In psychedelic sex therapy, the therapist’s role may involve guiding the patient through the psychedelic experience, helping to integrate insights and ensuring a safe and supportive environment,” according to Dr. Radowitz. “In contrast, traditional sex therapy focuses more on facilitating discussion, behavioral change and education within the confines of standard cognitive or somatic therapy techniques.”

Are There Any Risks?

Dr. Radowitz stresses that it’s crucial to work with a reputable clinician and therapist who has experience in screening out anyone with a contraindication to the use of psychedelics (including prior history of psychosis/schizophrenia or active mania in someone with bipolar affective disorder). He adds, “Also, it’s critical to make sure they are medically stable for treatment and there are no interactions with any of their current medications. It’s important to work with a therapist who is experienced and comfortable working with psychedelics, who could properly prepare, guide and integrate their experience.”

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Masturbation May Help With Menopause Symptoms

“Self-pleasure offers an effective, accessible tool.”

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With symptoms like hot flashes, trouble sleeping, and vaginal dryness in the mix, menopause can be a difficult experience for many women. However, there are treatment options available, including hormone therapy and lifestyle tweaks. Now, new research has pinpointed a lifestyle hack that can help women struggling with symptoms of menopause: masturbation.

That’s the major takeaway from early research released by the Kinsey Institute at Indiana University on September 16. Of course, this is an unusual treatment plan and it’s understandable to have questions about how, exactly, this all works. Here’s what’s behind all of this.

Meet the expert: Women’s health expert Jennifer Wider, MD.

What did researchers find?

Researchers, who conducted the surveys in partnership with in partnership with sexual wellbeing company the Lovehoney Group and its Womanizer brand, did so over two phases. The first phase surveyed 1,500 American adults between the ages of 18 and 88 to look at overall public knowledge about menopause. In phase two, the scientists surveyed 1,500 women between the ages of 40 and 65 to learn more about their experiences with menopause.

In the first phase, the researchers found that more than 75 percent of women knew that menopause was the permanent end of having a period. However, they also discovered that very few women would identify the symptoms of menopause.

In phase 2, the researchers discovered that 36.2 percent of women going through menopause said that they had an improvement in their symptoms when they masturbated. But while one in 10 women said they used self-pleasure as the main way they coped with menopausal symptoms, 46 percent of women said they would be open to trying masturbation to relieve their symptoms if it was recommended by a healthcare provider.

Can masturbation relieve menopause symptoms?

It’s important to point out that the researchers didn’t explore whether masturbation can relieve symptoms of menopause. Instead, they found that some women said it helped with their symptoms. (But this wasn’t studied in a lab or anything.)

That said, there are some theories on why this could help. “Masturbation has been shown to improve mood, improve sleep, and promote vaginal health,” says women’s health expert Jennifer Wider, MD. “This is why it may help alleviate some of the symptoms of menopause.”

By the way, Wider says that having an orgasm via sex may create similar results in some women. “In others who are experiencing vaginal dryness, intercourse will be painful and getting to the point of orgasm may be difficult and not have the same desired results,” she adds.

“This survey shows self-pleasure offers an effective, accessible tool for menopausal symptom relief, which is important to integrate with existing care strategies,” said Cynthia Graham, PhD, senior scientist at the Kinsey Institute, added in a statement.

Do doctors recommend masturbation for menopause?

As of now, it’s not common for doctors to recommend masturbation for menopause. However, it’s worth noting that five percent of the women surveyed by the Kinsey Institute said that their doctors suggested masturbation as a possible way to manage their symptoms. So, clearly some doctors are recommending it.

Ultimately, Wider says this is worth trying if you’re interested. “This is a risk-free recommendation and has little downside— and it has potential to alleviate some unwanted menopausal symptoms,” she says.

Complete Article ↪HERE↩!

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Six Signs You Should Go To Sex Therapy

— Psycho-Sexologist and host of Audible’s ‘Sex Therapy’ podcast, Chantelle Otten, on how it could improve your life.

By Chantelle Otten

If your sex life feels like it’s missing something—be it connection, pleasure, or understanding—it might be time to consider sex therapy. Often misunderstood, sex therapy is a powerful, judgement-free space that’s all about fostering deeper connections, improving communication, and embracing sexual confidence. No one knows this quite like psycho-sexologist and relationship expert Chantelle Otten, whose Audible Original podcast Sex Therapy takes listeners inside her sessions with anonymous, real-life patients. Whether you’re seeking guidance about mismatched libidos or simply after a better understanding of your body and needs, scroll on for the key signs that sex therapy could help you unlock a more fulfilling, empowered sexual life, according to Chantelle.

sex therapy 101

How can sex therapy contribute to one’s overall emotional wellbeing and personal growth?

Sex therapy can have a profound impact on emotional wellbeing and personal growth. Our sexuality is deeply connected to how we feel about ourselves, our relationships, and the world around us. When we’re able to explore and understand our desires, boundaries, and experiences without shame, it opens up space for greater self-awareness and confidence.

Through sex therapy, people can work through feelings of insecurity, past trauma, or relationship challenges that might be holding them back. By addressing these issues, they often find that not only does their sexual health improve, but so does their overall sense of self. It’s about giving people the tools to connect more deeply—with themselves and with others—leading to more fulfilling relationships, better communication, and ultimately, personal growth.

It’s empowering to realise that sexual health is an integral part of emotional wellbeing, and therapy helps people embrace that in a healthy, balanced way.

What are some common misconceptions about sex therapy that might deter people from seeking help?

One of the most common misconceptions about sex therapy is that it’s only for people with extreme issues or dysfunctions, but that’s far from the truth. Sex therapy is for anyone who wants to improve their relationship with their sexual self or their partner. People often assume they’ll be judged, or that it will be awkward, but it’s really about creating a safe, supportive space where they can explore their concerns without fear or shame.

Another misconception is that sex therapy is purely focused on the mechanics of sex. In reality, so much of what we work on is emotional—communication, self-esteem, intimacy, and understanding how past experiences shape current dynamics. It’s about the whole person, not just the physical aspect of sex.

Lastly, some people worry that coming to sex therapy means something is “wrong” with them, but it’s really about growth and empowerment. Seeking help is a positive, proactive step towards better understanding and enhancing your sexual health and relationships.

In what ways can sex therapy address issues beyond sex?

Sex therapy can actually address a wide range of issues that extend beyond just the physical aspects of sex. A lot of the work we do is centred around emotional connection, self-esteem, communication, and intimacy. For example, many people come in thinking their concerns are purely sexual, but often it’s linked to stress, anxiety, or unresolved emotional trauma. By working through these underlying issues, we can help people feel more secure in themselves and their relationships, which has a ripple effect on their overall wellbeing.

We also explore relationship dynamics—how partners interact, communicate, and express their needs. These skills translate into other areas of life, like building stronger emotional resilience and improving self-awareness. It’s about learning to connect with yourself and others in a more meaningful, authentic way, which ultimately enhances both your sexual and emotional life. So while the focus might start with sex, the impact of therapy can be much broader.

How does sex therapy integrate with other forms of therapy or counselling to provide a well-rounded approach to mental health?

Sex therapy often works hand-in-hand with other forms of therapy or counselling, creating a more holistic approach to mental health. Our sexual wellbeing is deeply intertwined with our emotional, psychological, and relational health, so it’s important to treat the whole person. If a client is already working with a psychologist or counsellor, sex therapy can complement that by focusing specifically on the sexual and relational aspects of their life.

For instance, if someone is dealing with anxiety, depression, or trauma, those issues often impact their sexual experiences or how they connect with a partner. In sex therapy, we can work through those concerns in a way that addresses both the emotional and sexual sides of things. By integrating approaches, we create a safe, cohesive space where clients can explore all aspects of their mental health without compartmentalising one part of their life from another. It’s all about treating the person as a whole, not just focusing on isolated symptoms.

What role does open communication play in the success of sex therapy, and how is this cultivated in sessions?

Open communication is absolutely essential to the success of sex therapy. So much of the work we do revolves around helping people feel comfortable enough to express their needs, desires, and boundaries—often for the first time. In therapy, we create a space where clients feel safe to talk openly without fear of judgement or shame, which is key to making progress.

In sessions, this is cultivated by encouraging honest, non-confrontational dialogue. We explore how to communicate clearly and compassionately with both yourself and your partner. For couples, it’s about learning how to listen and express themselves in a way that strengthens the relationship, rather than causing misunderstandings. We also talk about practical strategies, like using “I” statements or slowing down conversations to really understand what each person is saying.

Over time, these communication tools become part of the client’s daily life, not just in the therapy room. The more open and honest you can be, the deeper the connection you can build with your partner—and with yourself.

How can individuals or couples know when it’s the right time to seek sex therapy?

The right time to seek sex therapy isn’t just when you’re facing issues—it’s also when you want to learn more about sex, explore new sides of your sexual self, or deepen your connection with your partner. Sex therapy can be an empowering space to explore the fun side of things, gain valuable education, and understand more about your desires and boundaries. Whether you’re curious about enhancing intimacy, improving communication, or just wanting to feel more confident in your sexual experiences, therapy can help.

Of course, if communication around intimacy starts breaking down, or you’re noticing recurring issues like mismatched libidos or sexual dysfunction, that’s a sign it might be time to explore things further. But even if you’re not dealing with big concerns, sex therapy is also about growth, education, and discovering what feels good for you.

It’s all about taking a proactive step, whether it’s to resolve an issue or simply to learn and grow in your sexual wellbeing.

What are some of the most significant barriers people face when considering sex therapy, and how can they be overcome?

One of the biggest barriers people face when considering sex therapy is the fear of judgement or shame. Talking about sex can feel vulnerable, and many people worry that their concerns will be seen as abnormal or embarrassing. To overcome this, it’s important to remember that sex therapists are trained to create a safe, non-judgmental space where these topics are handled with sensitivity and care. Everyone’s experiences and challenges are valid, and seeking support is a positive step towards growth.

Another common barrier is the misconception that sex therapy is only for people with major issues. Many people think they need to wait until something goes seriously wrong to seek help. In reality, sex therapy is for anyone looking to improve their sexual health, whether that’s addressing concerns or simply learning more about sex and intimacy. Normalising therapy as part of a healthy lifestyle can make it easier to take that first step.

Lastly, some people might feel hesitant due to cultural or societal taboos around sex. Overcoming this involves recognising that sexual health is just as important as physical or mental health, and that seeking help is a way to enhance overall wellbeing. The more we talk openly about sexual health, the less intimidating it becomes.

How has the field of sex therapy evolved in recent years?

The field of sex therapy has evolved significantly in recent years, becoming much more inclusive, open, and attuned to the complexities of human sexuality. There’s a greater emphasis now on recognising the diversity of sexual experiences, from different sexual orientations and gender identities to non-traditional relationship structures like polyamory or open relationships. This shift has made therapy more accessible and welcoming to a broader range of people.

We’re also seeing more integration of mental health and sexual health, recognising that these two are deeply connected. Conversations around anxiety, trauma, and body image are often part of sex therapy now, as people understand that emotional wellbeing plays a huge role in sexual satisfaction and connection.

Another big change is the move towards normalising sex therapy as not just a last resort, but as a proactive and educational resource. More people are seeking therapy to enhance their sexual experiences, improve communication, and explore pleasure—not just to address problems. The field is growing to reflect the understanding that sexual health is a key part of overall well being, and that’s been a really exciting development.

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This Is How Kink Can Improve Your Relationship And Sex Life

— Kink is way more nuanced than we think.

By

Traditionally, most of us have considered kink to be something outside the conventional ideas of sex, however, a study by the University of Brighton has suggested that as many as 20-30% of the UK population has engaged in it.

Addtionally, according to Google Trends data, there has been an increased interest in “kink” since 2016 – no doubt helped by films like Fifty Shades of Grey and Nicole Kidman’s upcoming flick Babygirl, further normalising the practice.

However, according to one expert, there is far more nuance to this subculture than we think and, actually, kink is good for more than just spicing up your sex life. In fact, getting familiar with our kinks can actually improve our relationships overall.

HuffPost UK spoke exclusively with Gigi Engle, certified sex and relationship psychotherapist and resident intimacy expert at relationship exploration and dating app 3Fun, to learn more about what we should all know about this hot topic…

Everything you didn’t know about kink, according to an expert

Engle believes that to some degree, this sexual subculture is being misrepresented. Speaking about the popular films that depict kink, she says: “Kink in mainstream media often neglects the plentiful nuance and negotiation that goes into kink, instead choosing to sensationalise it.

“What we’re supposed to be seeing is something sexy and kinky, but what we’re really seeing is glorified abuse. This isn’t what kink is about. Kink is about boundaries, clear negotiation, and being 100% on board with everything.”

Unfortunately, she warns, this misrepresentation can lead to prejudice and even encouraging abuse. “We often see consent left out of mainstream depictions and this can lead to a lot of problematic outcomes such as people trying ‘kink’ in ways that are very unsafe, people thinking that if you’re into kink you’re into abuse and much more,” Engle explains.

However, while the sexpert acknowledges that this isn’t always the case, she does urge that filmmakers should work directly with sex workers who specialise in kink to help them to create better, more accurate representations.

Until then, Engle urges people to look at how (healthy) kink can improve their relationships, saying: “Kink allows couples to explore fantasy and power dynamics in a unique way. It can really open the doors to greater exploration and excitement, which can be great for deepening intimacy and increasing desire.

“It can aid in sexual communication through negotiation and boundary setting and allow couples to deepen trust by learning and trying things together in a safe way. Kink is part of how adults play. It’s how we get to know our deeper desires and explore together in a way that is bonding and often quite transformative.”

If you’re single, this is of course, a little more complex. Kink requires mutual trust, and an inherent feeling of safety, which isn’t always possible when you’re sleeping with new people.

Engle advises following these three steps to engage in kink safely as a single person:

  • Always vet partners. You want to ask for references if you’re going to do kink play with a new partner. It’s completely OK to ask to speak to former kink partners because this stuff can be really dangerous and shouldn’t be practiced by someone who doesn’t know what they’re doing.
  • Set clear boundaries and safewords with all new partners.
  • Practice alone. You can engage in what’s called “self dominance” or “self submission” where the power dynamics you’re playing with are with yourself. This can look like practicing Shibari rope tying on yourself, using toys on yourself with a set intention for dominance or submission, or using implements like flogger on yourself.

Complete Article ↪HERE↩!

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What doctors wish patients knew about pain during sex

By Sara Berg, MS

Experiencing pain during or immediately after sexual activity—known as dyspareunia—is a condition affecting many women, yet it remains a topic often shrouded in silence. This medical issue, which can affect both physical and emotional well-being, is more common than many may realize. Understanding and addressing this condition is crucial for promoting overall sexual health and quality of life.

Dyspareunia can affect men and women, but it’s more common in women. Pain during or after sex can affect about 10–20% of women in the U.S. This may be a low estimate, though, as many women don’t seek medical help for painful sex and therefore underreporting is likely.

It happens during or after sex

“Dyspareunia is any time women report pain with intercourse,” Dr. Savells said, noting it can also “be defined as anytime there is pain with sexual activity because that doesn’t always involve a partner.”

It is typically painful during sex but can also “include time immediately following that, so in the next several minutes, not a day or two later. That would be something else,” she explained.

Keep an eye out for these symptoms

“Symptoms can be external irritation—around the clitoris or around the opening of the vagina—but a lot of the time it is inside the vagina,” Dr. Savells said. “And that can be with initial contact or foreplay, or it can be with penetration.

“Some patients can even specifically differentiate the difference between pain that occurs as soon as a partner tries to enter versus that which occurs from deep thrusting,” she added.  “Being able to provide these kinds of details to your doctor can help them determine the cause.”

Menopause is a main cause

“The causes of dyspareunia include the thinning of skin and lack of estrogen that both occur with aging as women go through menopause,” Dr. Savells said. “This is very common. Probably about 40% of all menopausal women say they have difficulty with their intercourse, their intimacy.

“That can be due to both vaginal atrophy—which is thinning of the skin—and it can also be due to vaginal dryness,” she added. “A lot of women have both of those, but they are two distinct problems.”

There are other causes

“Patients who have pain with intercourse can also have muscle spasms in the muscles around the vaginal wall. These muscle spasms can cause pain with sex but can also be a cause of chronic pelvic pain that is unrelated to intimacy,” Dr. Savells said. “If they’ve had a painful intercourse experience in the past, it can cause them to be tense because there’s fear that pain will occur again.”

“It can be due to just stress and anxiety. Or it can be due to post-traumatic stress disorder from a previous traumatic event, such as assault or rape,” she said. Vaginismus, which is an involuntary tensing of the vagina that is often experienced at the start of sex, while inserting a tampon or while getting a pelvic exam, is another reason.

“Some patients can also have pain with sexual activity due to a skin condition called vestibulitis, which is an irritation of the skin at the posterior portion of the vaginal opening,” Dr. Savells added. “Unlike several of the other skin changes which can cause sex to be painful, this condition is often treated with surgery instead of topical creams.”

“Less commonly, some patients can have scar tissue from previous surgeries to their labia or their vagina. And yet another cause for dyspareunia can be an enlarged uterine fibroid, which can also cause pain with intercourse,” she said. “There are even some bladder conditions that can cause pain with intercourse.”

Additionally, “some patients as they get older will have something called vaginal stenosis or vaginal narrowing and the same vagina that worked with that partner 10, 15 years ago is now too small,” Dr. Savells said, noting patients will say, “I’ve got the same partner, why don’t we fit together anymore?”

“It’s because the vagina is actually getting smaller,” Dr. Savells said.

Dyspareunia is also common for women post-pregnancy if they had a traumatic vaginal birth or issues with prolapse.

Vaginal dryness is a concern

“Stress, anxiety and depression can all cause patients to have difficulty with the arousal component of their sexual function,” Dr. Savells said. “But as far as pain goes, a lot of times that’s due to the dryness.”

For example, “a lot of patients with cancer will have dryness due to their chemotherapy or other treatments they’ve had,” she said. “If patients have had pelvic radiation for uterine cancer or cervical cancer, they may have dryness and pain due to that.

“They may have scar tissue due to that, but even patients who’ve had chemotherapy for nongynecologic reasons can have a lot of vaginal dryness as a side effect of their medication,” Dr. Savells said.

Treatments vary depending on cause

“There are a lot of things that we can do to help patients who are having pain with sex. I don’t ever want anybody to feel like it’s their fault or they’ve created the problem,” Dr. Savells said. One of the most- common causes is “when a woman is having problems because they are estrogen-deficient. Lack of estrogen is the definition of menopausal and for most women, that is about 50 years old.

“But there are also much younger women who are also estrogen-deficient; if they have had an early hysterectomy or if they have had breast cancer and had to have their ovaries taken out,” she added. “For most women who are estrogen deficient, the primary thing we start with is estrogen cream. There are women with contraindications to estrogen therapy, however, so it is essential for patients to consult with their physician about whether or not this is appropriate for their individual situation.”

“If your vagina is out of estrogen, you just add back more estrogen. And for a lot of women that is very effective and fixes their problem,” Dr. Savells said. “There are also nonhormonal therapies for vaginal dryness and vaginal atrophy, so we have options even for those women who cannot take estrogen replacement too.”

For example, Dr. Savells’ practice has a MonaLisa Touch laser, which she said is “super effective.”

“Mona Lisa Touch treatments include lasering of the vaginal tissue and the tissue that surrounds the vaginal opening on the outside. As a result, all the skin in the treated area becomes thicker and stronger. This helps those women lubricate more-naturally when they become aroused, and also reduces the microscopic tears which cause many women to feel a burning sensation after sex,” she said. “For both pre-menopausal or estrogen deficient women, these treatments can be very beneficial. For patients who have vaginal spasms, pelvic floor therapy is helpful for them.

“But therapy is not a quick fix,” Dr. Savells added. “For immediate help, sometimes those patients will get injections into the muscles around the vagina to help relax those muscles so that they don’t spasm and have so much pain.”

“We also utilize compounding pharmacies to make vaginal suppositories that have muscle relaxers in them to help relax those muscles,” she said. “And sometimes patients will insert a vaginal suppository with a muscle relaxer in it a little while ahead of when they anticipate intercourse might happen. That will help relax them a little bit so that they don’t have as much discomfort.”

“For someone who has a condition called vestibulitis, which is a specific type of irritation in the skin at the posterior portion of the vaginal opening, surgery is necessary. Fortunately, this is a relatively minor procedure and simply involves excision of superficial skin in the affected area,” Dr. Savells said. “Sometimes I’ll see patients who just need a little bit of help, they’ve just had a little bit of narrowing and a very short course of dilator therapy, from four to six weeks, gets them back to where they want to be.”

Dilator therapy is a treatment that is used to gently stretch and expand your vaginal tissue over time. This improves its elasticity and reduces the pain you may feel during sexual intercourse.

“If your pain with intercourse is due to uterine prolapse or the uterus falling down, then a hysterectomy may be necessary,” she said.

It can affect your mental health

“Lots of women feel insufficient in their relationship at home. A lot of women feel less sexy or attractive and it causes significant relationship conflict in some households,” Dr. Savells said. “So, it’s kind of the chicken-and-the-egg discussion.”

“For some people, the anxiety, stress, a previous trauma, history of PTSD can lead to pain with intercourse,” she said. “And then for some patients, some other medical condition was the initial culprit of the pain with intercourse.

“But because of that, now they have anxiety or depression or feel like they’re less than,” Dr. Savells added.

Try pelvic floor physical therapy

“I’m a huge fan of pelvic floor physical therapy,” Dr. Savells said, noting that “physical therapy is great for patients whose pelvis floor muscles have gotten too relaxed as they get older and they may be having urine leakage, some stress incontinence, things like that.

“But it’s just as helpful for patients whose muscles are too tight, which is really where it plays into this discussion,” she added. “So, those patients with vaginismus—where they have lots and lots of tension in their pelvic floor muscles—a physical therapist is good at helping them learn to relax those muscles.”

“We don’t pick how we exhibit our anxiety or our stress or our attention and some patients just tend to have a lot of tightness in their pelvic floor muscles just like other patients report neck tightness or stiffness,” Dr. Savells explained. “A physical therapist can help patients learn to isolate those muscles—it’s not intuitively obvious—and help them learn to be intentional about relaxing those pelvic floor muscles.”

Continue treatment to prevent return

If dyspareunia is treated appropriately, the pain “shouldn’t recur as long as the patient is continuing their treatment,” Dr. Savells said. “Patients have had really good success. If they get the right diagnosis and the right treatment, most of them don’t have problems again as long as they maintain their therapy.”

For example, some “menopausal women will use their estrogen cream, get better and then feel like they are cured, and they will quit using their cream. Then a year later the problem comes back,” she said. “In the beginning it’s hard to convince people this is a chronic thing. This is your new normal.”

Set realistic expectations for sex

“If you surveyed thousands of women, about 40% of them across the board will say that they have concerns about their sexual function,” Dr. Savells said. “But a lot of times, especially in younger women, they have concerns that their body isn’t quite normal because of what they’re comparing themselves to or their partner is telling them that their sex drive is not as good as it should be, that their frequency of intercourse is not as good as he would like for it to be.”

“A lot of their concern about their sex life has to do with setting realistic expectations for them, reassuring them that their anatomy is normal, that their sexual frequency is in fact normal despite what television or social media tells them,” she said. “So, about 40% of women will say that they have sexual concerns, but only 15% of women have true sexual dysfunction, which means it’s interfering with their ability to perform—they can’t have intercourse, they don’t enjoy intercourse.”

Include your partner in the process

“If someone’s doing dilator therapy, that can involve a partner. If you’re doing marital therapy or sex therapy, obviously those involve a partner,” Dr. Savells said, noting “sometimes partners are affected by a woman’s treatment course in other ways, although not directly involved. If a patient requires gynecological surgery for her painful intercourse, then she will be required to abstain from sexual activity for a period of four to six weeks. This is a great opportunity for a partner to be emotionally supportive of her feelings and sexual health.”

“It’s important to include them in the communication so that they understand why this is hurting. A lot of times, it’s often important for patients to reassure their partner that it’s not you,” she said. “Men are often very affected by this problem as well because as soon as the woman is feeling pain, she’s withdrawing a little bit and not as eager to initiate sexual contact. … So, it very much becomes a problem for both of them.”

Don’t be embarrassed

“This should be something that your gynecologist is super comfortable having a conversation about,” Dr. Savells said, noting that “I probably have this conversation multiple times every day, so don’t be embarrassed.”

“Your gynecologist should be super comfortable talking to you about your sex life, the parts that are good, the parts that are bad, the parts that need improvement,” she said. “We have lots of options for how to help.”

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