181: When Sex Hurts – Dr. Irwin Goldstein

Dr. Irwin Goldstein, the founder of field of sexual medicine, joins me in the conversation about female sexual pain. He drives the talk with tons of fascinating information about sexual pain, including what are the different categories, common causes, and treatment options.

The prevalence of female sexual pain
Within the last month, 1/3rd of women reported experiencing sexual pain or some form of discomfort during sex, while only 2% to 7% of men reported sexual dysfunction or secondary pain. He urges women to ensure they find the correct medical professional and find answers to their questions as he has found many women go untreated due to misdiagnosis.

Dr. Goldstein best categorizes various kinds of sexual pain by the area it originates. The pain in the vulva is diagnosed as vulvodynia. However the vestibule is often overlooked as the source of pain, and more than 90% of the time is misdiagnosed as vulvodynia.

Hormonally Mediated Vestibulodynia
Dr. Goldstein warns against birth control pills as they have harmful side effects that can eventually affect your sex life. He urges women to consider other birth control methods like Long-acting reversible contraceptives (LARC) – IUDs, Nexplanon and Implanon contraceptive implants, and progesterone. He further informs that The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics no longer consider birth control pills as the leading method of contraception.

Causes in Older Women and Treatment Options
For older women over 40, the hormonal challenges of menopause are a leading cause of pain. He mentions that women go through two stages of menopause, where the first one causes low testosterone levels and the latter causes low estrogen levels. He shares available treatment options for this.

Other Common Causes and Treatment Options
Among other causes, Dr. Goldstein talks about Neuroproliferative vestibulodynia, a condition where women