Then there are also complications due to dermatologic conditions and potential infections like pelvic inflammatory disorder and various STIs to consider. “Yeast infections, desquamative inflammatory vaginitis; all [of these] can make the tissues extremely sensitive, irritative and painful,” cautions Tanouye. She explains untreated STIs can cause painful inflammation in the vagina, cervix, and uterus.
Tanouye also says not to discount UTIs and other uterine diseases as probable causes. Prescribed meds can help, as does thoroughly cleaning toys or other sexual aids while the condition clears.
Other Medical Conditions
Other common, painful causes can disrupt your sex life. For example, Lincoln states that physical issues such as fibroids and cysts can be truly life-altering. Additionally, Tanouye says conditions like endometriosis and adenomyosis, as well as issues with the pelvic floor, could also be the cause, including the involuntary spasms of vaginismus. Lincoln says other organs in that area, including the bladder and the bowel, might be to blame: “Bad constipation or interstitial cystitis: all those nerves are connected so they can all cause pain.” All that is to say: If you’re in pain, talk to your doctor. Ob-gyns have a host of remedies at their disposal, up to and including surgery when needed.
Lack of Access to Affirming and Literate Care
Danielle Jones, a board-certified ob-gyn hospitalist working in Texas, tells Allure that because of the lack of LGBTQIA+ affirming health care, many transgender and nonbinary people often avoid seeking treatment for pain, and even when they do, they often receive incorrect diagnoses or inadequate care. For example, though individuals who’ve elected to have bottom surgery may not be at risk for endometriosis, pelvic pain may be caused by other issues. “Neovaginas, in general, can lead to somewhat unique causes of pelvic pain, including vaginal stenosis — or narrowing of the vagina — which can be painful with intercourse or just in general.” Additionally, according to Jones, common vaginitis infections may occur slightly more frequently for those who have had bottom surgery, though Jones says these important issues can be diagnosed fairly easily by trans-inclusive providers.
Jones explains that a lot of trans men and nonbinary people with vaginas fall through the cracks of the medical system as well. While not every trans person decides to undergo hormone replacement therapy, fluctuations in hormones can play a role in pelvic pain, regardless of gender identity. A decrease in estrogen, for example, can be associated with a decrease in lubrication and less vaginal elasticity, which can be at least partially relieved by adequate lubrication and topical estrogen, according to Jones, if a person is willing and able to use it. “[Topical estrogen] doesn’t increase blood estrogen levels enough to counteract the testosterone they’re [taking], but it can make intercourse a lot less painful,” she says.
While the first impulse when looking for the cause of physical discomfort may be to look for a physical cause, the cause may actually be emotional. In fact, past or current trauma, including domestic violence and sexual trauma, can often have a direct impact on sexual comfort. “Oftentimes, the way domestic abuse presents in our office is people complaining of recurrent problems,” explains Jones. “Sometimes that could be pain with intercourse, infections we are not finding — all kinds of things bring people in when they would like to outcry about domestic abuse, but don’t know how. The onus is on the health-care team to be taking a good history and asking the right questions to assess for that.”