Episode 39: Painful sex? Let’s talk about it

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Dr. Sophia ObGyn podcast. On today's podcast, we're gonna talk about a topic that honestly, women wish we talked about, but it's obvious that we don't speak enough about it because of taboo discomfort. Just not sure who to talk to, and that is the matter of painful sex. One of the reasons why I wanted to bring this topic to the forefront was because I speak to so many women, and very often I am the first person that they will either confide in or ask questions about the fact that they may be having painful sex. And so I, of course, in talking with Touseef, decided that this was a topic that we should cover, and I'm super excited about it. So, as always, I am joined by my very good friend and co-host, Touseef Mirza.

Touseef Mirza:
Hi everyone. So, yeah, so this is an interesting conversation because, like you said, we don't usually talk about it. What I was telling Sophia is this is something that people don't talk about, but that they Google a lot because you don't want people to know about it. And so we usually do this in secrecy because we think maybe something's wrong with us or there's shame involved, or we just feel dirty about it. And so there's a lot of different connotations. So we just want it to clear the air up and have a really honest, open conversation about all the different facets of if you've ever had painful sex or if you wanna know more about it. So we just wanna be able to have a really open, loving conversation about it.

Dr. Sophia:
Yeah, I think starting from the heart and also from the aspect of sex as health. You know that concept. So if we look at sex as part of health, then painful sex is something that should be addressed the same way we address pain in our back. Pain in our stomach, a headache. There really should be no excuse for why we can't address pain with sex.

Touseef Mirza:
Because at the end of the day, it's a body part like any other.

Dr. Sophia:
It involves body parts like any other, and like any other part of your body, it should be in a state of homeostasis-

Touseef Mirza:
Balance.

Dr. Sophia:
You know, there should be some balance. And when we think about sex, sex is something that's supposed to be pleasurable. It's supposed to be a means to an end in terms of reproduction. However, the process is one that should be enjoyable. And so it's important that we definitely have this conversation.

Touseef Mirza:
There's a lot of ground to cover. When me and Dr. Sophia were looking at that, we're like, oh yeah, we have to talk about this, and we have to talk about that. So the first thing I think, because that is on top of most people's minds, is that number one is painful sex normal?

Dr. Sophia:
Excellent question. And I think we should think about it in terms of perhaps situations. Is painful sex normal? I think one can expect to have some degree of discomfort when you have sex for the first time. And so when a woman has sex for the first time, her vagina has to accommodate for, and we're talking about cis women here, we're just gonna talk in terms of let's say, heterosexual coupling. And so sex for the first time, including penetrative sex, definitely can be uncomfortable. And even to the point of some pain, because the vagina now has to accommodate and open for the penis.

Touseef Mirza:
Which it has never had to do before.

Dr. Sophia:
Exactly. Which not only it has never had to do before, but we do have something, a part of the vagina called the hymenal ring. And that part of the vagina, though elastic yes, but initially can be very tight

And for most women, it actually takes several attempts. I have a patient for whom it took after getting married, she'd waited to have intercourse after marriage, but it took her a year to quote unquote consummate her marriage. It took her a year before she could have penetrative sex, and that was with very slow progress. In terms of being able to, I guess, tolerate the discomfort or the pain that she was anticipating, there was definitely a part anxiety and part physical.

Touseef Mirza:
So stress can also induce that level of discomfort because the body feels stressed, so it can't relax.

Dr. Sophia:
Some women have never even had things such as a finger or a tampon or, you know, placed inside of the vagina. So many women don't even know their own body parts. And so if you just go with even just a finger and you say, oh, that feels uncomfortable, then the possibility of putting something that's even bigger than that. The vagina is very nerve wracking. And so in this particular patient's case, it took us, she came in because she needed to have a physical exam. And with that physical exam included doing something called the pap smear. And on our initial visit, I told her, I said, listen, we're not going to do a pap smear for you , which-

Touseef Mirza:
Basically means that you are putting an instrument inside the vagina.

Dr. Sophia:
Vagina. Yeah. The pap smear includes using a speculum and using that instrument in order to be able to see inside of the vagina. And I said to her, "Okay, we're not gonna do this today. Instead, she's someone who had never used a tampon, for example, before. And so we had a series of visits where I had her buy a dilator set.

Touseef Mirza:
What's a dilator set?

Dr. Sophia:
A dilator set is a set of what we call dilators. These are instruments that are used in order to open up a small opening. So we use, and then they're cylinders and different varying degrees of how large they get. They're usually very smooth. They can be made out of silicone. And you know, they start with very small ones that can be the size or the, the size of, let's say a pinky. And then they gradually get bigger, let's say, to accommodate the size of a typical male penis. Okay. And so we started with her coming in on perhaps, I don't remember if it was like a weekly basis or something of her first becoming comfortable with just inserting the smallest dilator into her vagina and, and realizing that it doesn't have to be painful because

Touseef Mirza:
-it is a cavity?

Dr. Sophia:
Because it is a cavity. Yes, it is. It's a cavity. It's a canal. That is, this is, you know, know our bodies are meant for this.

Touseef Mirza:
Right. Because I think you bring up a good point because I think just the concept, like, I'm just thinking about the first time I put a tampon in and I was just like, oh my God, where-

Dr. Sophia:
Did it go?

Touseef Mirza:
Oh, yeah. Where did it go? . I'm supposed to put this inside my body. Like that concept, I mean, I know, you know, we eat, we put stuff in our mouth, but that's, you know, we've been used to it since we were babies. But this part of actually manually putting something inside the body, that concept is pretty scary the first time.

Dr. Sophia:
Well, it can be scary for a lot of reasons, for a lot of women. And in this particular patient, you know, she came to me kind of, I don't wanna say desperate, but certainly the feeling of I wanna have a baby. I wanna be able to be intimate with my husband, and I haven't been able to. You know, because she just had both a physical and mental block. I won't even say that. It's just a mental block, because physically, she just was very narrow in terms of her vaginal opening.

And so having to put that on stretch in order to accommodate a penis was just, it, it, it was very, very anxiety-provoking for her. So after working with her, she was able to then work at the same time at home. But I think understanding and being able to like even just touch herself and touch her body, which is something that she had never done before, in order for me to just share with her and explain to her, these are your body parts. This is your clitoris, for example, this is your vaginal opening, for example, place your own hand there in order to understand what it feels like and all of that she'd never done. And having, I think it was almost like when we were having the conversation, her and I, it almost gave her permission as if that's one of the things that she was waiting for,

Touseef Mirza:
For somebody to give her permission.

Dr. Sophia:
And, you know, as a physician and as an ObGyn, it was as if I was the person of authority, kind of giving her that feeling that she can be armed with her own capacity to take care of herself.

Touseef Mirza:
On that note, can you please tell all the listeners, because you are an ObGyn to give them permission as well?

Dr. Sophia:
We should all feel very permitted to understand our bodies, every single part of our bodies, every aspect of our bodies, it is ours. If there's anything I can impart on women, it is that our bodies are sacred. Our bodies are ours. The best person to know it is you. And once you know your own body, then it makes it that much easier to therefore be able to share it in a way that is loving and pleasurable to you. So definitely, I don't need to give you permission, but if it's just the validation of that point, then I'm happy to do it.

Touseef Mirza:
Because I think there's one part that you said that, you know, our bodies are sacred. And I think sacred can mean different things to different people. And part of it feels that, therefore, it needs to be pristine. And because sex is considered dirty, the sacred part actually becomes an obstacle to actually fully experiencing the pleasure of our own bodies.

Dr. Sophia:
I guess when I think of the word in terms of sacred, I think of it as your body, as your temple. And yes, what does that mean? It means you should have full access to it. You are the master of your own body. You are in control of your own body. You have complete autonomy over your own body,

Touseef Mirza:
And you get to learn about your body, and you get and know your body.

Dr. Sophia:
And know your body. Yeah. And, and so for me, in that sense of it is, is more so the knowing, the feeling connected to it, the feeling of always just protecting it, even with your own self. But I definitely understand how the word itself can be very conflicting.

Touseef Mirza:
And loaded. Yeah.

Dr. Sophia:
And a very loaded question under so many different guises. But again, I really wanna empower women to understand the importance of simply being fully connected to their body. So that's one point. And then again, from a physical standpoint, your body is meant to be able to have sex. Sex is a part of health. And though the first time, so you the original question was of, is it normal? And there are many in many circumstances where sex can be painful and that pain can be considered normal, but it's not forever. That discomfort that can happen with sex is not one that's supposed to be long-lasting, let's say after the first or second time. Right. But it is a concept, right? We don't talk about it. We don't really express this when we talk to our young women about what sex can feel like and what it can be like the first time, the first time doesn't have to be, is not necessarily gonna be ooo la la you know? And I think that it's important to have an honest conversation about that.

Touseef Mirza:
So in the situation with your patient, you said that you gave her the dilator set.

Dr. Sophia:
Dilators.

Touseef Mirza:
Dilators. And then what else can you recommend? Because we did talk about like, the obvious one seems to be the lubricant.

Dr. Sophia:
Lubricant. Absolutely. Absolutely. Now, granted your body again meant for sex. Our brains are connected to our vaginas. And so when aroused, our bodies create natural lubricant. But imagine in a state where your mind is yes. Although saying, yes, I want to do this, I want to try this, but at the same time feels conflicted because it's concerned that it may feel pain or it may have a lot of discomfort associated with it. Or just anxiety provoking.

Touseef Mirza:
I just wanna say, when you say that our bodies create lubricant, we're basically saying when we say I'm wet, that's what we're saying. You got it. We got wet. Okay. I just, I just wanna be very clear, 'cause we don't say, oh, I got lubricant going on down there, we say, I'm wet, I'm ready to go.

Dr. Sophia:
And this is why we have you on the show. Thank you. Thank you very much. Thank you very much. No, definitely we're talking about being wet. Okay, thank you. We're talking about feeling juicy, I mean, however you'd like to call it. Okay. But that is the reality. Okay. And so, yeah. And that's a, that is a, a vagina brain connection. And can actually happen just as a reflex at the level of the vagina, that if the vagina is touched in a way that it, it will signal the, the concept of the lubricant or you know, the wetness to come, your brain also has the ability to block it. You know? And so if you're in a circumstance where you are, though desiring a little apprehensiveness, having extra lube is like a gold mine.

Touseef Mirza:
Lube is your friend.

Dr. Sophia:
Lube is your absolute best friend. Yes. Okay. Lube is your absolute best friend because whatever will make the situation that much easier. And that's another thing so many women feel like, even just to say to their partners that they may need lubrication under so many different circumstances. We haven't even touched the, the surface yet of talking about why women may need a lubricant aside from some other, you know, mental disconnect with their bodies, but physical reasons, menopause, perimenopause, vaginal dryness, vaginal issues that can be causing a lack of lubrication at the level of the vagina. And so lubricant is important and an essential part of the sexual experience. And so to have it as part of your toolkit, you know, in your toolbox, is essential.

Touseef Mirza:
Easy access. Easy

Dr. Sophia:
Access. Like right

Touseef Mirza:
At arm's length.

Dr. Sophia:
At arms length, you can go grab it, use it, you know. But I think a lot of women definitely feel either embarrassed, ashamed, or that something's wrong with them if they have to. I agree. Or if they have to go and use it, grab it, use it, ask their partner to use it or what have you. And I think we need to have a different conversation. We need to express it as if, ooh, I got a new lube. You know, let's try it, let's try it.

Touseef Mirza:
And it could actually be pleasurable for your partner, also.

Dr. Sophia:
Absolutely. So many men, you know, often say that they like a very wet vagina. And so it should be a pleasure for both parties, but also understanding that both people want to give pleasure. You know and, and to that end, then to use all methods to make that happen. Lubricant is numero uno.

Touseef Mirza:
I think also, it's important to talk about women, if they are having issues more specifically, like being wet and being lubricated, that something is wrong with them. But stats actually show that this is not something that's abnormal.

Dr. Sophia:
Not at all.

Touseef Mirza:
The stats actually say that one in almost out of three women…

Dr. Sophia:
Experience some form of vaginal dryness or some type of painful sex.

Dr. Sophia:
Painful sex.

Touseef Mirza:
Yeah. So I think even for like, when I heard that stat, I'm like, why didn't we talk about this before? Like, I think we can remove so much stigma around it if we realize also that it's not about me.

Dr. Sophia:
The concept that a woman can experience some form of pain with sex up to, you know, at any point in her life is up to 30%.

Touseef Mirza:
I think also when we talk about painful sex, there's painful sex that happens like during the moment. And then is there also painful sex, where you continue to feel pain after sex? Yes. So can you talk a little bit about either Yes,

Dr. Sophia:
Yes. There's the concept of pain with the initiation of sex. There's a concept of pain on initial penetration. There's a concept of pain with deep penetration. There's the concept of pain after the sexual act where the woman continues to feel discomfort or pain afterwards in her pelvis, whether at the level of the vagina, whether at the level of the pelvic floor, or at the level of the abdomen.

Touseef Mirza:
So when you say pelvic floor, what do you mean?

Dr. Sophia:
I'm talking about the muscles. The tissues all in and around the pelvis, not just the vagina itself.

Touseef Mirza:
Okay. The pelvis being.

Dr. Sophia:
And so the pelvis encompassed all of those parts, with pain at the level of her lower abdomen. So there are so many different ways and places that a woman can experience.

Touseef Mirza:
So it can radiate.

Dr. Sophia:
It can, it can radiate, it can, they can have the sexual, actual experience itself be fine. And then it's after sex that they then start to have these like either cramps, contractions, or feelings of just pain deeper inside of their body.

Touseef Mirza:
Then I guess the question becomes if you are having pain, and let's say you use the lube, and then finally it was more about vaginal dryness, and then, you know, you, you're, you're able to address that, get past that. Yeah. And, and, and things do go out, like go smoothly. So you always start with that. But then if, if you still have pain, I mean, the

Dr. Sophia:
In reality, there's so many reasons for the pain. There are just so many reasons for the pain. I have another patient that comes to mind because especially if you're a woman who has been having sex for whatever amount of time and everything has been going great, you've been experiencing pleasure, and then all of a sudden you start to feel pain with sex. And whether that, and, and let's just say pain with sex, meaning that you, when you have sex, you then have either burning during the sexual experience, itchiness during the burn, the sexual experience, a feeling of rawness or swelling, especially at the level of the vagina with your sexual encounter. Then it's more likely that there may be something acutely going on. There may be something that's happening at the level of the vagina that's causing you to then have this kind of discomfort. And it could be a number of things, and very easy and simple things to actually deal with, for example, a very common infection such as BV or an infection such as yeast. Two of which can happen due to changes in your pH balance for we're not gonna go into that. We've already discussed pH balance and vaginal discharge.

Touseef Mirza:
We'll put that in the show notes where that episode is.

Dr. Sophia:
But the reality is, those are very common infections that are not necessarily STIs, but can happen. And a woman may not necessarily notice that she has a yeast infection or that she has a BV or bacterial vaginosis infection and then goes to have sex and then has pain discomfort with sex. And that then becomes the reason why she comes in to see her ObGyn

Touseef Mirza:
As a woman who's, if she's having pain, she's not gonna know the reason why. Right. So at that moment, if it's not being resolved by vaginal dryness or you know, that you're not like super relaxed or there's a physiological issue at that point, it's not for us to figure out, oh, I should get a yeast I should go to the pharmacy and get a yeast treatment. I should go to the OB-GYN.

Dr. Sophia:
I think that for a woman who's having normal, regular sex without pain, and then all of a sudden develops pain, and she, and with all things being the same, the same partner, she's not necessarily, let's say perimenopausal for example, she's let's just say she's a 33-year-old woman.

Touseef Mirza:
So no hormonal issues. No hormonal issues, the same, same

Dr. Sophia:
Partner. She, you know, no hormonal issues, same partner, and life for herself has, has basically relatively stayed the same. She's in the same job. Like everything for her is the same, but all of a sudden she's got painful sex. Yeah. She should come in and be examined. Let's figure this out. Let's see if there's something happening at the level of the vagina that's causing it. . The other day, I had another patient who came in who was complaining of burning and discomfort with sex. When I examined her, she had what looked to me like herpetic lesions, and she'd never, which means which herpes she had. She had small little things, and they were very nondescript.

Like it would be something that you, you would, you could easily dismiss. And her, as a woman, it's interesting, she was a Muslim woman. I said, well, have you looked, did you look to see what was hurting, bothering you or whatever? She says, no. And I said, okay. Again, the concept of just knowing our bodies, but nonetheless, on exam, she had these little small lesions that I initially said, okay, well did you have sex today? So that I could understand, well, were these the small abrasions that perhaps from having sex that I was looking at? And she said, no, I had sex three days ago. And so if it were three days ago, even if she'd had abrasions, those abrasions typically after three days would've already healed.

Touseef Mirza:
So when you say abrasions, it's basically like-

Dr. Sophia:
small cuts in the skin or small.

Touseef Mirza:
Okay. That sometimes is due to friction

Dr. Sophia:
That can be due to friction. Yes. Okay. That can occur. And so I decided to test her, you know, and so now this is a new, another place where I now have to have a conversation with her, in terms of saying, well, I think you have herpes. Herpes is a sexually transmitted infection, this means, and she says, well, how can that be? I've only been with my husband. I said, okay, I'm not saying that your husband is being an infidel. It quite be, it could quite be that he had this and didn't know, and you got this when you guys first got together, but being the fact that you are three months postpartum, she's still in a recovery phase in terms of her body and also just being worn down from being a new mom, or, well, this was like her third kid, but that part too.

Like, so she's running around three kids now, you know, so her body is taking a physical toll. The bottom line being that the last thing on her mind was the possibility that she had an STD or, or that that would be the cause of her pain with sex. But at the end of the day, that's in fact what it is.

Touseef Mirza:
But she would've never known unless she would've come and seen you. Right. To understand why am I having this painful sex? A yeast infection, a yeast treatment would've done nothing. Right?

Dr. Sophia:
So for her specifically, a few weeks from now, she may have it, it would just be gone. So I would just imagine the amount of women who actually have that exact same experience, who may not have come to me. Who may not have come in because the first time, the second time it's painful. They're like, you know what, let me just take a pause until I feel better. A week and a half later, they feel better. And there we have it. No wiser that the problem was that there was a herpes lesion

Touseef Mirza:
But I think it's empowering to go see if I've done everything that I could, if I'm having painful sex from a lubrication standpoint in terms of, you know, where my mindset is at and how open I am, at least if I go see the ObGyn or my doctor, and the understanding and knowing, oh, this is what's happening with my body.

Dr. Sophia:
Empowering, understanding that it's not something that's just in your mind, nothing. Your vagina didn't break on you all of a sudden.

Touseef Mirza:
So I think it's just really because of the stigma associated with it, the more that we can explain and rationally show this is why it's occurring, you can actually let go of your own mindset of putting yourself down because maybe something's wrong with you. I mean, yes. Physiologically something is going on, but at least you know what it is. It's not something psychological.

Dr. Sophia:
Absolutely. And so again, from an acute standpoint, the concept, you were fine, and then all of a sudden you're not fine coming in to be checked out and to understand what could potentially be that. Cause that's just one thing. Women can develop things like fibroids, benign tumors of the uterus, and they can also occur at the level of the cervix. And so I had a woman once who came in who said, you know, I was, I was fine before, but now I find that in certain positions, I have a lot of pain when I have sex. Come to find out on her exam, she had a fibroid, which is a growth again, that the benign growth of the uterus and can also happen at the level of the cervix that was now in a place where in certain positions, she was feeling a lot of discomfort with sex that she had no idea of, because when she's not having sex, she's not having pain.

Touseef Mirza:
And that's because there was a mass somewhere. Yeah. That was now there's this-

Dr. Sophia:
There's like this mass effect. Exactly. There's this mass now that was there that was causing her feeling of pain that she just didn't have any idea of. And without having come in to see me, she would never have known typically of fibroids. Many women have them, and they don't know that they have them, but certainly if they're in certain positions in the uterus and in and around the uterus, yeah. They can be a, a, a cause of pain during sex. Some women have something called endometriosis. Endometriosis, which is again, a benign condition, but can be pretty severe in that it's a pretty severe pain syndrome that can happen with endometriosis, and it causes scar tissue on the inside and can cause women to feel a lot of pain and discomfort again, with sex.

Touseef Mirza:
So for example, in those situations that we just talked about, which is, we talked about yeast infection, we talked about bv, we talked about endometriosis, we talked about fibroids. That's a lot of different potential causes of painful sex in, for example, in this situation, does a lubricant help?

Dr. Sophia:
A lubricant is not going to necessarily make someone who has endometriosis pain go away. Someone who has fibroid pain goes away. Someone who has an active STI goes away. No. Okay. A lubricant is not going to help that situation. If you have an active yeast infection, your vagina is probably gonna feel like it's on fire when you're done having sex. So even if you can, you have the ability to have sex at that moment, but afterwards, that burning sensation just from the friction. And your partner may even feel like the sex was uncomfortable if you actually have a yeast infection. In what way? Because of the fact that it causes a certain level of friction, it doesn't allow the vagina to be lubricated in the way that it normally would be. And so because of that, your partner may also feel like it wasn't a pleasurable experience.

Dr. Sophia:
Mm. When we are talking about lubricant and why, I mean, for, for many, many, many, many women, sex is emotional and mental. If you don't feel necessarily connected with your partner, if you're not in the mood, if now is not the right time, you're thinking about your baby who's crying in the next room, your body may not trigger that wetness. And so yeah, a lubricant could help for sure. If you're a woman who's postmenopausal and experiencing significant vaginal dryness because of the lack of hormones, and you don't even have to be postmenopausal, meaning after menopause, you could be perimenopausal and experience significant vaginal dryness. For some women, that's some of their first signs. They're like, what is happening here? I want sex. I wanna be able to have sex. And yet they are not; their bodies are not responding. So mentally, emotionally, they want to be connected.

Dr. Sophia:
They're turned on. They're turned on, and their bodies are not actually on board with the program because they can't, it can't produce the juices. That's correct. Because of the estrogen, 'cause of the lack of the estrogen or the, the, the sporadic changes that are just happening in terms of their hormone and hormone balance and the way that estrogen works at the level of the vagina. So yeah, when I say things like, okay, start with a lubricant. Sure. But understanding all of the different reasons why that could be a good place to start, but that there are so many other reasons why a woman can experience painful sex. I have another client whose uterus is tilted in a specific way, and I know many women who are like, oh, I have a tilted uterus. Oh, my doctor said my tilt, my uterus tilts towards the back.

Dr. Sophia:
Your uterus is like your nose. It can be a skinny nose, it could be a fat nose. Like your uterus can be in so many different ways. Okay. Which are completely normal. Let me re, let me just say this one more time, which can be completely normal. All right? But for some women, the cervix can be a point of pleasure or it can be a point of pain. So the cervix being the lowest, most part of your womb, or the part that opens up into the, to in the vagina, the cervix is the lowest, most part of your uterus that allows menstrual blood flow. For example, this is the part of the body that's going to open for birth and your cervix is the part of your body that we're, we can see when we look inside of the vagina as an ObGyn, in order to do things like test for sexually transmitted infections and do a pap smear. Okay. Cervix. Cervix is actually a firm, it's firm. I like to ex for women when they do explore their bodies to understand what it's going to feel like, typically, like the tip of your nose. Mm. And they don't expect to feel something that's kind of hard. . You know, because the vagina itself is kind of squishy, soft, and warm. You know what I'm saying? But if you can get as far as to reach your cervix, then it's, I want women to expect to know what they're going to feel

Touseef Mirza:
About. How far is it in the vaginal canal, approximately?

Dr. Sophia:
I would say that most women can probably feel their cervix after about five centimeters. But the point is that for some women, the nerve endings that go to the cervix when touched can be either pleasurable or painful. Certain sexual positions make it that the cervix is more accessible versus not. And so even having the conversation about sexual positions that are more pleasurable, just because of your own normal anatomy, it takes paying attention to your body. It takes wanting to understand how things work and feel.

Touseef Mirza:
So for example, if you're having penetration with a penis. So the penis could touch the cervix?

Dr. Sophia:
Potentially.

Touseef Mirza:
Potentially. And it's not gonna go through the cervix.

Dr. Sophia:
No, it doesn't go through the cervix.

Touseef Mirza:
It doesn't go through. Absolutely. So it might touch it or come close enough to it that might radiate certain muscles around it, right? . And affect it. And that might either be pleasurable or, or not exactly. Depending. And that has nothing to do with you. This is just how your body is.

Dr. Sophia:
And, and I think one of the elephants in the room that we haven't talked about at all is a woman's history of any sexual violence or trauma. At the end of the day, women who have experienced any type of sexual violence or trauma are at a increased risk of having pain with sex. And this is where it does take the mental and emotional liberation and healing that has to happen in order for them to fully enjoy sex, enjoy their bodies, and enjoy their partners.

Touseef Mirza:
And that might take some time and

Dr. Sophia:
That can take months, years. It requires women to actually acknowledge that that could be the connection with why they have pain.

Touseef Mirza:
There's so many different scenarios and physiological aspects of having painful sex. But I think at the end of the day, if you're having painful sex stop

Dr. Sophia:
Oh, absolutely. If it hurts,

Touseef Mirza:
Stop like period. And then also don't say, oh, it's my fault. I think that's the second thing. And then try, try to then see whether or not it's potentially a simple solution or not, and then seek help. Another one that we just, we didn't even get a chance to touch on yet is the concept of birth trauma to the vagina.

Dr. Sophia:
That has led to some form of discomfort of the pelvis. Whether that's discomfort with sex, whether that's discomfort with urine urinating, whether that's discomfort with or problems when it comes to having bowel movements. I mean, there's just, that is a whole other episode, but when we were talking about the concept of what else could be normal, certainly your first time having sex. But I like to, when I talk to my patients after having a baby, I say, listen, don't be surprised if when you have sex for the first time after you've had your baby, that it again can feel painful like the first time.

Touseef Mirza:
Because all of the tissues internally or around your pelvic floor have just gone through.

Dr. Sophia:
I have gone through this major experience of having to give birth to a child. And it's almost like a recovery of the muscles and the tissue of repair and reconstruction.

Touseef Mirza:
We covered a lot of ground in terms of all the different aspects. And I think this is something that we just don't talk about, which I'm so happy that we are, and really putting it in the forefront. But I think the first, for me, what I'm taking away from this, like the first or the second thing, is, number one, we need to stop blaming ourselves.

Dr. Sophia:
Definitely don't blame yourself. We need to address is there an actual physiologic thing that's happening that we can actually solve for?

Touseef Mirza:
Actually, I wanna go back. Okay. I think the first one is not that it stops, it stops. That is correct. First one,

Dr. Sophia:
You're the first thing. If you are having sexual pain, stop. Stop. Let's figure out why you are having the pain. There are a number of reasons, and none of them are your fault.

Touseef Mirza:
And there are certain things that you can do. Like if, if it is something that's simple, then it's the lubricant and also knowing your body and communicating with your partner. But there are a lot of other situations where you will not be able to solve it. And you need to go see your healthcare practitioner, your ObGyn,

Dr. Sophia:
Your ObGyn, your nurse practitioner, whoever you feel the most comfortable with. Perhaps you can bring this up with your primary care physician who will refer you to the right specialist. The bottom line is, do not suffer in silence. I think many, many women accept the fact that perhaps painful sex is, maybe it's supposed to be painful or that they've never experienced pleasure in it. So therefore they just think that's just how it's supposed to be. How fast can we get this over with? And we are having this conversation because I want to remind women, sex is a part of your health. This is the concept here, sexual health. And in that there should be associated with it. Pleasure. We are human, and it's a part of the human experience that we have the ability to have that be a part of our reproductive system.

Touseef Mirza:
Yeah. The vagina was designed to have pleasure.

Dr. Sophia:
Yes. And give pleasure.

Touseef Mirza:
Yes. And give pleasure. It wasn't just designed to have the babies

Dr. Sophia:
And give pleasure to yourself.

Touseef Mirza:
Yes.

Dr. Sophia:
Your body understanding, your body, embracing your body, having grace with your body,

Touseef Mirza:
And loving your body no matter what.

Dr. Sophia:
No matter what, no matter how you look, no matter what it looks like, no matter what it feels like it's yours. So you are going to be the best person to know what feels good to you, what is painful to you, what is interesting. And you know, like you, you have full agency over your body.

Take care of it, enjoy it, love it, touch it. Know it, know all of your parts the same way. You know your ears, your nose. Know all of your parts. Embrace your body. Embrace yourself. Thank you so much for joining us on today's episode of the Dr. Sophia ObGyn podcast. I hope that this episode brought some levity and allowed you to feel just more open on a topic that can be a little bit hard to discuss. Until next time, thank you for listening. Bye

Touseef Mirza:
Bye.

Dr. Sophia:
This is General medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.