Concerns & Sexual Problems

Painful Sex

Painful sex is most often reported by women, although it occurs in people of all genders. Painful sex can be a result of health conditions, psychological and physical factors, or a combination of both. Painful sex can put stress on a person or relationship, especially if pain is ongoing or recurrent (also known as dyspareunia).

Ongoing or recurrent pain during sex can be caused by:

scars in the vaginal entrance caused by an episiotomy, sexual assault, or adhesions under the foreskin of those who are uncircumcised;
allergic reactions to latex in condoms or diaphragms;
sensitivity to ingredients in spermicides or lubricants;
skin conditions or infections including lichen sclerosus;
inadequate lubrication;
prostate problems that cause pain on ejaculation;
Peyronie’s disease or other inflammations or scarring of the penis or internal male reproductive organs;
vaginismus, a condition where the muscles around the vagina spontaneously tighten, which can make any touch or contact inside the vagina feel uncomfortable or painful;
vulvodynia, which is characterized by long-term pain or discomfort around the vulva;
pelvic pain or disorders including pelvic inflammatory disease;
sexually transmitted and blood borne diseases including chlamydia and gonorrhea;
thinning of the vaginal tissue (as a result of age, scarring, and hormonal changes);
and endometriosis, which is a chronic disease where tissue similar to the lining of the uterus (the endometrium) grows and implants outside of the uterus on other parts of the body.

For people with endometriosis, painful sex may be attributed to fibroids, ovarian cysts, pelvic adhesions, scar tissue, hormonal fluctuations, and inflammation. People with endometriosis may also experience vaginismus or vulvodynia, or experience vaginal bleeding during penetrative sex.

Individuals with a hymen (a thin piece of tissue located at the vaginal opening) may experience a small level of temporary pain due to the opening of the hymen the first time that they have sex. This may cause some pain or bleeding, though it does not happen to everyone.

If you experience pain during sex, be sure to tell your partner it hurts. If pain persists beyond the first few instances of sexual intercourse and inhibits your ability to enjoy sex, it is best to consult your doctor.

Endometriosis Resources

If you suspect that you may have endometriosis, you can learn more about it through the information on this website and the resources linked below. These resources are for informational purposes only and are not meant for self-diagnosis.

Premature Ejaculation

Premature (or rapid or early) ejaculation is when males consistently ejaculate more quickly than they or their partners would like them to during stimulation or intercourse. Premature ejaculation is a common sexual problem that affects most males at one time or another.

Ejaculation may occur immediately prior to or just after stimulation or insertion of the penis into the partner, without any sense of voluntary control. Causes of premature ejaculation include over-stimulation, anxiety over sexual performance, and stress. It may also be due to a male’s lack of awareness of the preliminary sensations that lead to orgasm, making him unable to control the process leading to ejaculation.

There are several possible solutions to dealing with premature ejaculation:

The squeeze-pause technique is commonly performed with the male lying down. His partner stimulates the genital area until the penis is erect, then squeezes the penis for 3-4 seconds by holding the penis with the thumb on the ridge between the head and shaft, and the first two fingers situated on either side of the ridge opposite the thumb. This squeeze eliminates the desire for ejaculation. This technique should be repeated several times during genital stimulation, so that foreplay can continue without ejaculation.

Once mastered, this method can also be used in intercourse; the female partner inserts the penis into her vagina and then sits on top of the male motionless. When the male feels close to ejaculation, his partner lifts off of his penis and administers a squeeze, then returns to the sitting position. Over time this results in ejaculatory control.

The stop-start method works to make a male more aware of his sensations as he is approaching orgasm. His partner manually stimulates his penis while he focuses on his sensations. When he feels that orgasm is approaching, he has his partner stop the stimulation. The extreme sexual tension will be diffused, and then the partner can begin restimulation. Once the couple becomes proficient at this, then the procedure is applied to intercourse or penetration.
Condoms may also help to delay ejaculation in males who have trouble with premature ejaculations.

A sex therapist may be able to help males and/or couples work on the problem of premature ejaculation if these techniques are not helpful.

Erectile Dysfunction

Erectile dysfunction is defined as an inability to achieve or maintain an erection firm enough to have satisfying intercourse. At one time or another, almost every male experiences erectile dysfunction.

Some causes of erectile dysfunction can include:

Some surgical procedures, including cancer surgery of the colon, bladder, or prostate gland;
Certain medications, such as drugs used to treat high blood pressure, and those prescribed for depression or insomnia.

Certain medical conditions, such as diabetes, heart conditions, and kidney and liver diseases;
Performance anxiety, fatigue, stress, or excessive alcohol or drug use;

If you are having increased difficulty achieving and maintaining an erection, talk to your doctor. There are many treatment options available. If you are in a relationship, you should also talk to your partner – communication on this sensitive topic can help ease some misunderstandings or false assumptions.

Low Libido

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A person’s desire for sex can change over time and can be affected by other aspects of their life like medical conditions, hormonal changes, stresses and distractions.

Libido imbalance, or desire discrepancy, where one partner wants more sex than the other, is a common problem in long-term relationships and a common cause for relationship problems, particularly for those who have difficulty communicating with their partner. Many sex therapists say it’s the problem they encounter most often in their work.

Quite often, the partner who has the higher drive feels hurt and rejected when sex does not happen and the partner with lower drive feels pressured and resentful at having to perform when they don’t feel up to it. The best solution is usually for both partners to reach a compromise. The higher-drive partner should understand that each person has their own natural sex drive and should not feel rejected when their drive doesn’t fall in line with their partner’s.

Finding non-sexual romantic ways to boost their partner’s libido may also prove helpful. Dealing with the libidinal feelings by masturbating or redirecting is another approach. For the partner with the lower drive, it is important to understand that their partner is not trying to pressure them.

Responding to non-sexual cues can also help enhance sex drive. Many times, being with a partner, holding them while they masturbate or masturbating them is an alternative that appeals to both partners.

If there is a large discrepancy, such as one partner wanting sex every night of the week and the other only once a week, they could agree to engage in sex twice or three times a week. Often this requires more of an attitude change than a physical change. Consider seeing your doctor or a sex therapist if low libido or desire discrepancy is cause for concern or disagreement in your relationship.

Vaginal Dryness

Some females experience vaginal dryness.

After menopause in particular, a female’s body produces less estrogen, which causes the vagina to become less elastic and to have less natural lubrication. There are many practices and products that can help stimulate your natural lubrication:

Use a lubricant.
Water-based sexual lubricants or lubricants made specifically for the older woman are widely available. These come in gels and suppositories, and should be applied liberally to the vagina just prior to sex.

Enjoy getting there.
Make foreplay a focus. Applying a lubricant can make a wonderful addition to foreplay. And spending a little more time on foreplay can set you up to be more responsive, interested and excited about sex.

Moisturize yourself.
Vaginal moisturizers also help increase vaginal moisture and elasticity.

Sex and Aging

Women

There is no age limit on sex for women. Although older women may become aroused more slowly than younger ones, many find that their desire increases when they no longer have to worry about being interrupted by young children or about getting pregnant.

Most older women, especially those who remain sexually active, retain the ability to have normal orgasms. But as women age, their bodies change and so do their sexual organs.

Menopause and lubrication

After menopause, women’s bodies produce less estrogen (the female hormone).

The lower estrogen level creates some physical changes that may affect sexual activity. You may find that it takes longer for your vagina to swell and lubricate when you’re sexually aroused. Your vagina also becomes less elastic.

This may make intercourse less comfortable or even painful. Some women even avoid sex because they find it less pleasurable than before.

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You shouldn’t have to suffer through painful intercourse just because your natural lubrication just isn’t doing the job. There are other ways to make entry smooth and enjoyable. There are many practices and products that can help stimulate your natural lubrication:

Use a lubricant. Water-based sexual lubricants or lubricants made specifically for the older woman are widely available. These come in gels and suppositories, and should be applied liberally to the vagina just prior to sex.
Enjoy getting there. Make foreplay a focus. Applying a lubricant can make a wonderful addition to foreplay. And spending a little more time on foreplay can set you up to be more responsive, interested and excited about sex.
Moisturize yourself. Vaginal moisturizers also help increase vaginal moisture and elasticity.

Have sex more often

The more you have sex that includes vaginal penetration, the easier it is for you to maintain lubrication and elasticity.

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Hormone therapy

Hormone therapy can relieve vaginal dryness. Talk to your doctor about the options that are available in Canada.

Decreased desire

Women may experience a decline in libido after menopause. This can be a source of distress and loss for many women – while other women are not at all bothered. The reasons for the loss of libido are not fully understood.

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Testosterone plays an important role in creating sexual thoughts and arousal in both young men and women, but in menopause, this relationship isn’t as clear.

In some cases, a decrease in desire can also be related to a number of other factors, such as depression, stress, fatigue or the use of some medications (for example some high blood pressure medications and some antidepressants). If you think that you or your partner’s loss of sex drive is a side effect of a prescribed medication, talk to your doctor before deciding to stop taking the medication.

Men

Men have their own set of issues that have an impact on their sexual activity. As with women, there is certainly no age limit on sex for men. However, older men generally take longer to achieve an erection, have a less firm or rigid erection, are less likely to ejaculate prematurely, and, take longer, after sex, to be physically ready to have sex again.

As with women, many of these physical changes in sexual arousal are the result of hormonal changes. Men go through their own changes related to a decrease in hormones as they age, most commonly in their early 50s. The decline in hormone levels (in this case, testosterone – the male hormone) is more gradual than the rapid fall in estrogen levels that mark the onset of menopause for women.

At about age 30, men begin to produce less testosterone, although testosterone levels vary and some 70 year olds have testosterone levels that match the levels found in some 30 year olds.

While hormone replacement therapy for men (or testosterone therapy) is available, it has potential risks. Always talk to your doctor or health care provider before considering any medication.

While the decline in hormone levels is gradual, it can still lead to very real physical effects, such as:

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Erectile Dysfunction (ED)

Erectile dysfunction or ED is not a direct result of aging. But the diseases that may come with age do increase the risk.

Erectile dysfunction is when a male has a frequent or continuous problem achieving and sustaining an erection. ED can be caused by mental, emotional, or physical factors. It can also be a side effect of certain medications, or drinking too much alcohol.

The first step in dealing with ED is finding out what’s causing the problem. As soon as you notice that you are having erection difficulties, you should visit your doctor for a checkup. Don’t just assume that impotence comes with age. It doesn’t. And it could be a sign of an underlying problem.

Some approaches that have worked for other males include:

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Medication

There are medications for ED available in Canada. But there are side effects, and interactions with other drugs, so talk to your doctor about whether medication is right for you.

Vacuum devices

This mechanical device is just what it sounds like – a type of vacuum. The penis is placed in a tube that is pumped to create a vacuum. This causes an erection, which is then maintained by slipping a tension band (like the penis ring) around the base of the penis.

For other options, and to discuss any medication that you might be on for other conditions that might be contributing to the problem, speak with your doctor.

Remember, there is much more to sex than a hard penis making penetration. Treating ED should involve both you and your partner. You may need to work together to restore intimacy and sexual confidence. Keep the lines of communication open. Spend time pleasing each other without keeping the focus on erection or penetration.

Decreased Desire

Declining levels of testosterone may lead to loss of energy and sex drive, common in both males and females.

But it doesn’t mean that you should put your sexual activities on the back burner. Keep your sex life alive by making time for it, talking about the changes you are going through and trying out different approaches that allow you to get excited and enjoy sex and your partner.

Other factors that can also contribute to fading desire include relationship problems, stress, depression, and medication. If your efforts don’t seem to make a difference, talk to your doctor or health care provider.

Penis ring

This works for males who get, but can’t maintain an erection. An elastic ring is slipped over the base of the erect penis to maintain the erection until ejaculation.

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Body image

Some people may not feel comfortable with the way their bodies are aging. They may feel that their new wrinkles, grey hairs, or weight gain make them unattractive. They may also harbour these feelings about their partner. These feelings have an effect on our ability to seek out and enjoy intimacy.

If you, or your partner, are struggling with your self-image, try to remember that your vitality, sensuality, and desire to love don’t fade as the years progress. Passion, about yourself and your partner, is still an important part of your life. Being attractive and sensual does not fade with age, it just changes.

Focus on your strengths
Pamper or treat yourself and your body
Try on a new activity or interest
Remind yourself that the whole point of sexual intimacy is to give and receive pleasure

Decreased Desire

A decrease in desire may mean that you need to find new ways to keep your sex life fun and exciting. Making your sexual relationship a priority will help keep you and your partner close and connected. Take time to reconnect. Many couples find that when they are away on holidays together, they rekindle their sex life.

Find time for sex in “prime time”. If you wait until you are exhausted at the end of the day, you will probably want sleep more than sex. Keep physically active. Sex takes energy, and staying fit will give you energy to burn.

Deal with any problems or challenges as they arise. It is challenging to have a good sexual relationship if the relationship itself is a bit weak. Don’t be afraid to experiment and reinvent your love life. What worked years ago might be ready for a refresh. While sex as you age might take a little more effort and commitment than before – from both partners – that doesn’t need to make it any less pleasurable.

How Much Is Too Much?

It’s completely natural to have sexual feelings, fantasies or desires at some point in your life. (It’s also completely normal if you don’t.) If you find yourself overwhelmed with constant thoughts about sex and having constant sexual desires, whether you act them out or not, you should consider whether these sexual thoughts are interrupting your life.

Are they making it hard to concentrate in school or at work? Are they affecting your relationships? Are they leaving you depressed and upset? If this is the case, you might want to seek help and talk to someone you trust.

Sexual addiction is the inability to control sexual urges, behaviours, or thoughts. It can be difficult to regain this control, especially if you’re unable to ask your friends or family for help. In many cities, there are anonymous counseling groups just like Alcoholics Anonymous (AA), called Sexaholics Anonymous (SA) where you can meet with others who are dealing with similar concerns and get help.

Endometriosis Resources

Websites:

Multimedia:

The SOGC Women’s Health Podcast:

Information and Tools:

Endometriosis Resources for African, Caribbean, and Black Patients

Endometriosis Resources for Indigenous Patients

Endometriosis Resources for Gender-Diverse Patients

There are several possible solutions to dealing with premature ejaculation:

Some causes of erectile dysfunction can include:

A person’s desire for sex can change over time and can be affected by other aspects of their life like medical conditions, hormonal changes, stresses and distractions.

Some females experience vaginal dryness.

Women

Menopause and lubrication

Have sex more often

Hormone therapy

Decreased desire

Men

While the decline in hormone levels is gradual, it can still lead to very real physical effects, such as:

Erectile Dysfunction (ED)

Some approaches that have worked for other males include:

Medication

Vacuum devices

Decreased Desire

Penis ring

Both

Body image

Decreased Desire