When it comes to sex, sometimes the spirit is willing but the flesh says, "Ow!" If love-making has become painful, see your gynecologist. Possible causes…

  • Dryness. Insufficient vaginal lubrication can be caused by dehydration. side effects of birth control pills or antidepressants...and decreased levels of the hormone estrogen after menopause.

What helps: Drink 64 ounces of water daily. Try an over-the-counter (OTC) lubricant, such as Replens, available at drugstores. Extend foreplay to give your body time to create lubrication.

Prescription topical estrogen also can help. It is less likely than oral estrogen to increase risk for cardiovascular problems and breast cancer. Options include a vaginal estrogen cream or an estrogen-containing ring inserted into the vagina.

New research: A low-dose vaginal estrogen suppository or ring (about 10 to 25 micrograms) is as effective as a higher-dose product for relieving dryness yet is less likely to cause side effects, such as headache and breast pain.

  • Endometriosis. When tissue from the endometrium (uterine lining)—which should stay inside the uterus—instead attaches itself to organs outside the uterus, it causes pelvic pain and inflammation for women in their reproductive years.

Options: Take an OTC non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, etc.) or naproxen (Aleve), starting the day before your period is due and continuing until bleeding stops. To halt disease progression, your doctor may prescribe oral contraceptives. In severe cases, surgery to remove endometrial tissue and adhesions can relieve pain while preserving fertility—though symptoms may recur. If pain is extreme and you are done having children, you may want to consider a hysterectomy.

  • Pelvic inflammatory disease (PID). A bacterial infection of the reproductive organs. PID results from a sexually transmitted disease (such as chlamydia or gonorrhea) or other vaginal infection. Repeated douching and using an IUD (intrauterine device for birth control) can increase risk. PH) symptoms include painful intercourse, vaginal discharge and abdominal or back pain.

Caution: PID can cause scarring that leads to infertility and chronic pain. Antibiotics cure the infection but cannot reverse damage.

Your partner: He must see his doctor, even if he has no symptoms of infection (such as pain or discharge from the penis)—without treatment, he could reinfect you.

  • Trichomoniasis. This parasitic infection usually is transmitted sexually but in rare cases can occur if genitals come in contact with an object that harbors the parasite, such as a wet towel. It causes vaginal odor, yellow-green discharge, sores on vaginal walls, genital itching and pain during sex.

Cure: One large dose of an antibiotic, such as metronidazole (Flagyl), can work as well as a seven-day lower-dose course of treatment—but it increases risk for side effects, such as nausea and vomiting. Your partner also must be tested.

  • Uterine prolapse. This occurs when weakened muscles and ligaments of the pelvic floor allow the uterus to drop into the vagina, creating pressure in the vagina or a lump at the vaginal opening. Contributing factors include pregnancy, childbirth, obesity, chronic constipation and decreased estrogen.

Self-help: Kegel exercises strengthen the pelvic floor. Contract vaginal muscles as if to stop the flow of urine...hold five seconds...relax... repeat. Aim for 30 repetitions daily.

Treatment: Your doctor may fit you with a pessary—a flexible plastic device worn in the vagina to reposition the uterus. Some can be worn during sex. If a bulge protrudes from the vagina, your doctor may recommend surgery to repair the pelvic floor...or a hysterectomy.

  • Vaginismus. Involuntary spasms of the pubococcygeus (PC) muscles surrounding the vagina make intercourse extremely painful. Possible causes include pelvic or vaginal infection or injury...lingering pain (or fear of pain)...hormonal changes...or psychological issues.

Relief: Treat any underlying physical cause—with medication to cure an infection or with hormone therapy for low estrogen. Kegel exercises, physical therapy and biofeedback help relax the PC muscles.

In the privacy of your home: Your doctor may recommend vaginal dilators. phallic-shaped rods of various sizes. Starting with the smallest (tampon-size), you gently insert the dilator into your vagina, working up to larger dilators over time until you can comfortably accommodate penetration by your partner.

  • Vulvodynia. This chronic condition is characterized by stinging or stabbing pain in the vagina or vulva. The cause may be related to genetics...infection...or injury to vulvar nerves, such as during childbirth, especially if you had an incision or tear at the vaginal opening. There is no known cure.

What helps: Medication options include an anticonvulsant or tricyclic antidepressant to block pain signals...and injections of the anesthetic lidocaine. Physical therapy and biofeedback help relax pelvic muscles.

Avoid: Hot tubs, tight underwear, scented toilet paper and perfumed soaps.

For more comfortable sex: Apply a topical anesthetic, such as lidocaine cream, 30 minutes before intercourse. This will diminish sensations of pain (and also, unfortunately, of plea-sure). Use a vaginal lubricant...and apply cold compresses after lovemaking.

Get Tested Every Year

Annual HPV tests are recommended for women over age 40.

Recent finding: 25% of women who tested negative on a Pap test but positive for the human papillomavirus developed abnormal cervical cells within five years. HPV is linked to cervical cancer.

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