Intercourse no longer feels good — what's going on?

Dear Reader,

Changes in one's sex life, if it's usually pretty good, can be frustrating and upsetting. A huge list of things can interfere with sexual pleasure, desire, and/or response. Some of these factors affect an individual's sex drive (desire to have sex or libido); others impact orgasm; and, still others cause discomfort or pain during intercourse.

Considering the sudden onset of this change in your sex life, it would be a good idea to get a pelvic exam as soon as possible. The cause may be as simple as vaginitis, or even a retained tampon.

If the results of the pelvic exam do not explain the inconsistent discomfort, other factors may be at issue. Medications, such as antidepressants, antipsychotics, blood pressure medications, and tranquilizers, can interfere with orgasm. Medical conditions, such as diabetes, multiple sclerosis, or other problems that interfere with normal nerve functioning, can cause problems with orgasm, too, so a full physical exam from your health care provider is your next step.

Pain during intercourse can be due to vaginal dryness (e.g., hormonal shifts after childbirth or menopause), not being quite aroused or ready enough for penetration, or deeper pain in the abdomen during penetration (called dyspareunia). Sometimes women with fibroids (non-cancerous or benign fibrous growths within their uterus) or a condition called endometriosis (in which tissue from the uterus becomes displaced into abnormal areas within the abdomen) can feel pain. Vaginal or pelvic infections make intercourse uncomfortable as well. Soap allergies can also be a factor.

Stress, depression, past sexual trauma, and relationship issues are other factors that can interfere with desire, orgasm, enjoyment, and/or comfort.

Being unable to enjoy reliably a sexual relationship can be frustrating, and definitely deserves attention from professionals who can help you sort out the laundry list of possible causes, so that you can also get some ideas about feeling more pleasure, with or without penetration. Your first step is to contact a gynecologist for a women's health physical and/or your health care provider for a check-up.

If a physical exam does not turn up any explanation, perhaps you and your partner could speak with a sex therapist or a couple's counselor. To locate a sex therapist in your area, try visiting the American Association of Sexuality Educators Counselors and Therapist (AASECT) for a referral.

Perhaps you could also think about when and what you noticed about this change in your sexual pattern. What coincided with your lack of desire and onset of discomfort? Did your boyfriend touch or handle you differently? How are you feeling about him, about your relationship, about your communication? Is he responsive and caring to you in sexual and non-sexual situations, and you toward him?

You might consider having outercourse, lovemaking without penetration, so that you are experiencing pleasure. Sex therapist Marty Klein's books, Let Me Count the Ways: Discovering Great Sex without Intercourse and Beyond Orgasm: Dare to be Honest about the Sex you Really Want, might give the two of you ideas to talk about and do together.

Lastly, sometimes a change is experienced with contraception, or because of things that are said or unexpressed feelings. These feelings deserve to be recognized and dealt with. Best of luck determining the cause of your recent displeasure,