Dyspareunia- Pain during or after intercourse, for men or women. It can be caused by many things, such as:

• Illness

• Infection

• A physical problem

• A psychological problem

The first thing to do if you have pain during or after intercourse is to seek advice from your GP, or a healthcare professional at a dedicated sexual health clinic. They will try to find the cause of the problem, whether physical, emotional or both, and be able to tell you whether you need any treatment.

The nearest to NW4 is: https://www.nhs.uk/services/service-directory/edgware-community-hospital/N10983865).

If there is an emotional reason for your problem, such as anxiety or previous trauma, Chana has specifically trained psychosexual therapists, both male and female, that can help support you.

For more information and explanations see https://www.nhs.uk/common-health-questions/sexual-health/why-does-sex-hurt/

Erectile dysfunction (impotence) is very common, particularly in men over 40 but also in men below this age as well. Erectile dysfunction means that a man is either:

• Unable to get an erection

• Unable to keep an erection for long enough to have intercourse

Sometimes, you might also have a low sexual drive.

It is usually nothing to worry about, and will go away on its own, but if it continues for more than a few weeks it is important to get assessed by your GP to rule out any underlying causes.

Possible causes of erectile dysfunction:

Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes can include:

• Narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol or diabetes

• Hormonal problems

• Surgery or injury

Psychological causes can include:

• Anxiety

• Depression

• Relationship difficulties

For more information on causes and treatments see https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

Loss of libido, also known as a low desire or low sex drive, is when someone’s interest in engaging in intimate relations reduces or disappears. It can affect men or women at different stages in life, and there are many possible reasons that this might happen. Usually, treating the underlying cause will solve the problem. Some causes of low desire include:

• Relationship problems

• Stress, anxiety, or depression

• Sexual problems

• Pregnancy, childbirth or breastfeeding (these can affect both men and women)

• Some forms of contraception

• Other hormonal changes, e.g. because of ageing

• Significant life events

• Medical conditions and some medications

• Mental health or other emotional difficulties

• Alcohol or other substance misuse

Treatment for low desire will depend on what the underlying problem is. As you may imagine from the list above, this can vary widely and will potentially involve one of several approaches.

You should contact your GP in the first instance, in order to make sure that there is no underlying medical reason for what is happening – and to begin treatment if there is. If there is no underlying medical issue, they may recommend a range of solutions, some of which may involve individual or couples therapy.

Chana has several appropriately qualified therapists on our team of Support Workers, who will be able to assist you in this regard.

This is a women’s body's automatic reaction to some or all types of vaginal penetration. Whenever penetration is attempted, your vaginal muscles tighten up on their own, making intercourse painful or impossible.

This is a form of dyspareunia for women and should be investigated by a GP or other healthcare professional first. You can ask to be seen by a female doctor, and you can bring someone you trust along for support. Your doctor will ask you about your symptoms and may ask to physically examine you. The examination is usually external only and is very quick. It is only to rule out other conditions, such as an infection.

If your doctor thinks you have vaginismus, you may be referred to a specialist, such as a psychosexual therapist, of whom there are several at Chana who can support you. It may also help to see a specialist physiotherapist. Chana can also provide further information on this.

For more information, causes and treatments see https://www.nhs.uk/conditions/vaginismus/

Vulvodynia is persistent, unexplained pain in the vulva. The vulva is the female genital area including the skin surrounding the opening of the vagina.

It can be caused by a number of different things, but is not contagious and is nothing to do with personal hygiene. It can affect women of all ages.

Symptoms of vulvodynia

The main symptom is persistent pain in and around the vulva and vagina. The pain may be:

• burning, stinging, throbbing or sore

• triggered by touch, such as during sexual intercourse or when inserting a tampon

• constantly in the background

• worse when sitting down

• limited to part of the vulva, such as the opening of the vagina

• more widespread – sometimes it can spread over the whole genital area and the anus

Some women also have problems such as vaginismus (where the muscles around the vagina tighten involuntarily), interstitial cystitis (a painful bladder condition), painful periods and irritable bowel syndrome (IBS).

You should see your GP or visit your local sexual health clinic if you experience persistent vulval pain. They will ask you about your symptoms and medical history, and may also conduct a short physical examination before advising you further. You can also ask your GP for a referral to a specialist vulval clinic if the pain persists.

There are a number of potential treatments they may recommend, such as medication, gels, physiotherapy or psychosexual therapy. These can address different elements of your experience of vulval pain.

Chana’s team of psychosexual therapists are available to support you with the many ways in which vulvodynia can affect your life, as well as your partner’s.

Things you can do to help with vulvodynia

There are some things you can do that may help reduce symptoms:

• wear cotton underwear and loose-fitting skirts or trousers

• avoid scented hygiene products, such as feminine wipes, bubble bath and soap (an emollient is a good substitute for soap)

• apply cool gel packs to your vulva to soothe the pain

• use petroleum jelly before swimming to protect the vulva from chlorine

• try not to avoid sexual intercourse or touching your vulva completely, as this may make your vulva more sensitive. If it is painful, try to find a position that's more comfortable, or seek advice if penetration is painful

• try to reduce stress, as it can increase the pain of vulvodynia

• for pain when sitting, using a doughnut-shaped cushion can help

Support groups and more information

Living with a painful condition like vulvodynia can be frustrating and stressful. You may find it useful to contact a support group for more information and advice, or to get in touch with other women who have vulvodynia.

The 2 main support groups are:

• the Vulval Pain Society

• the Pelvic Pain Support Network

For more information and explanations, see https://www.nhs.uk/conditions/vulvodynia/