Women’s Sexual Health Annual: Pain, libido, infections, pelvic floor basics

Sex should not hurt. Low desire, burning, leaking, or repeat infections are common—but not “just part of aging” or “something to live with.” This guide shows what to watch for, when to get help, and what your family doctor can do.

What you’ll learn

• Simple signs that mean “book a visit” vs. “watch and see.”
• What happens at the appointment and the tests you may be offered.
• Treatment options that are doable at home—and which need a clinician.

Why your sexual health annual matters

A yearly check-in with a primary care or family medicine provider helps catch pattern-based issues early: changes in cycle, pain with sex, urinary symptoms, or mood/medication effects on desire. Cervical cancer screening is also part of routine care. Current USPSTF guidance: ages 21–29 usually screen with a Pap test every 3 years; ages 30–65 can screen every 5 years with primary high-risk HPV testing (clinician- or self-collected in clinic in draft guidance) or choose other recommended options with your clinician. Final screening plans depend on age, history, and prior results. uspreventiveservicestaskforce.org+2uspreventiveservicestaskforce.org+2

Pain with sex (dyspareunia): causes & relief

Common causes

• Vaginal dryness or genitourinary syndrome of menopause (GSM)
• Skin conditions (e.g., dermatitis, lichen sclerosus)
• Pelvic floor muscle overactivity (“high-tone” pelvic floor)
• Infections (yeast, BV, trichomonas)
• Endometriosis or other pelvic conditions
• Medications or insufficient arousal/lubrication

Pain with sex is common at some point in life, but ongoing pain is not “normal” and responds to evaluation and treatment. acog.org

Signs & symptoms

• Burning or sharp pain at the opening vs. deep pelvic pain
• Post-sex spotting, new discharge, or odor
• Pelvic muscle tenderness or spasm on exam acog.orgjournals.lww.com

When to seek care (clear thresholds)

• Severe or worsening pain; pain plus fever
• Bleeding after sex
• Pain persisting >3 months or limiting intimacy
• New discharge/odor/itch or concern for STI acog.orgcdc.gov

What to expect at an appointment

• Focused history (location of pain, timing, cycle, menopause status, meds, mood, stress)
• Trauma-informed exam if needed; you can pause/stop anytime
• Swabs or urine tests to look for infection; discussion of pelvic floor involvement cdc.govjournals.lww.com

Treatment—pros/cons (examples)

• Lubricants/moisturizers (non-hormonal): easy access; may need routine use
• Topical vaginal estrogen for GSM: effective for dryness/pain; usually low systemic absorption; not for everyone—discuss history and risks PubMed
• Pelvic floor physical therapy for high-tone/pain: improves coordination and relaxation; requires regular sessions and home practice journals.lww.com
• Treat infections when present (yeast/BV/trich): targeted meds shorten symptoms; some meds interact—review with your clinician cdc.gov
• Behavioral/sex therapy: helpful when pain/desire are linked to stress, relationship, or past experiences; time commitment varies (expert-guided). acog.org

Low libido: what’s normal vs. not

It’s common for interest to rise and fall with stress, sleep, hormones, and life changes. It becomes a clinical issue when low desire lasts ≥6 months and causes distress (sometimes called HSDD). First steps: review health conditions, mood, relationship stressors, and medications (some antidepressants and others may affect desire). acog.org

Options

• Lifestyle & relationship supports, sex therapy, addressing mood/sleep
• Medication review (adjusting meds that reduce desire when safe)
• FDA-approved options for premenopausal women with HSDD may be considered after evaluation (discuss pros/cons, side effects).
• Off-label transdermal testosterone (mainly for postmenopausal women) can be considered under specialist guidance with monitoring; not FDA-approved for women in the U.S. (benefits/risks must be reviewed together). ISSWSHOxford Academic
  

Infections & discharge: UTIs and vaginitis

Vaginitis (BV, yeast, trichomonas) causes discharge, odor, itching, or burning. Testing guides treatment; partners are treated for trichomonas. Safer-sex practices lower risk. cdc.gov+1

Urinary tract infections (UTIs)

• “Recurrent” usually means ≥2 UTIs in 6 months or ≥3 in 12 months. Work-up rules out other causes. auanet.orgurology.wiki
• Options include patient-initiated antibiotics for proven recurrences, non-antibiotic strategies (hydration, timed voiding), and vaginal estrogen in menopause; long-term antibiotics carry resistance and side-effect risks. Decisions are individualized. auanet.orgurology.wiki

Pelvic floor basics: strength, relaxation, support

The pelvic floor is a “sling” of muscles supporting the bladder, uterus, and bowel. Problems include leaking, prolapse (a “bulge” sensation), constipation, and pain. Not everyone needs “Kegels”; with pain or high-tone muscles, relaxation and coordination work—often with a pelvic floor physical therapist—are first line. acog.orgjournals.lww.com

When to seek care (quick checklist)

• Pain with sex that’s persistent, severe, or new
• Bleeding after sex or between periods
• New discharge/odor/itch, or a known STI exposure
• Pelvic heaviness/bulge, or urine/stool leakage affecting daily life
• ≥2 UTIs in 6 months or ≥3 in a year
• You’re due for screening or want to discuss contraception, fertility, pregnancy, or menopause care auanet.orguspreventiveservicestaskforce.org

What to expect at your visit

• A private conversation about symptoms, cycle/menopause, meds, mental health, and goals
• Cervical screening or STI testing as appropriate
• Pelvic exam only if it adds value to diagnosis/treatment (you can ask to stop or defer)
• A plan you help design: home strategies, prescriptions, labs/imaging, and follow-up cdc.gov

Bring this 5-question risk scan to your checkup.

1. Do you have pain with sex (at the opening or deep)?
2. Has your interest in sex dropped—and does it bother you?
3. Do you leak urine with cough/laugh or feel a pelvic “bulge”?
4. How many vaginal or urinary infections have you had in 12 months?
5. Any bleeding after sex or new discharge/odor/itch?

Tests & treatment options (pros/cons at a glance)

• HPV/Pap screening
  
  
  • Pros: finds cell changes early; evidence-based intervals reduce procedures
  • Cons: abnormal results can be stressful; follow-up may be needed uspreventiveservicestaskforce.org+1
    
• Targeted infection testing (vaginitis/STIs/UTI)
  
  
  • Pros: directs the right medication; may reduce complications
  • Cons: false negatives/positives can occur; some meds interact with others cdc.gov
    
• Pelvic floor PT
  
  
  • Pros: improves pain/leak/prolapse symptoms with skills you can keep using
  • Cons: requires visits and practice; benefits build over weeks journals.lww.com
    
• Topical vaginal estrogen (GSM)
  
  
  • Pros: effective for dryness, pain, some urinary symptoms
  • Cons: not right for everyone; review personal risks and preferences PubMed
    
• HSDD therapies (behavioral, medication options)
  
  
  • Pros: targeted to cause; can improve satisfaction
  • Cons: some options have side effects or are off-label; monitoring needed ISSWSH
    

Prevention & doable lifestyle steps

• Use lubricant and consider vaginal moisturizers if dryness is an issue. PubMed
• Don’t “power through” pain—note patterns and triggers and book a visit. acog.org
• Urinate after sex if you’re UTI-prone; discuss prevention if infections repeat. auanet.org
• Practice diaphragmatic breathing and bowel habits that don’t strain; avoid “just-in-case” peeing. journals.lww.com
• Keep up with cervical screening based on age/history. uspreventiveservicestaskforce.org
  

Local How-To: how this works at Alabaster Healthcare (Eagan, Minnesota)

• Hours: Monday in-person 8:30 AM–4:30 PM. Tuesday–Friday virtual only 8:30 AM–5:00 PM.
• Good for telehealth: libido concerns, medication review, test result follow-ups, pelvic floor triage, and planning. Exams and swabs are done in person.
• What to bring: your medications/supplements, last period date (if applicable), and the 5-question risk scan above.
• Next step: book online | call | join waitlist—we’ll help you choose in-person vs. virtual for your concerns.
  

Trust Builders

Doctor’s perspective
 “Most problems—pain, low desire, leaking, or repeat infections—get better when we look for the pattern and treat the cause. Bring the 5-question risk scan to your checkup so we can start with what matters most.”

Myths vs Facts

Myth	Fact
“Pain with sex is normal after childbirth or menopause.”	Pain is common but not inevitable; targeted treatment helps most people. acog.orgPubMed
“Kegels fix every pelvic problem.”	With pain or tight muscles, Kegels can worsen symptoms; relaxation and PT are first line. journals.lww.com
“Low libido means a relationship problem.”	Desire is multi-factor: health, meds, mood, hormones, stress, and relationships. Help exists. acog.org
“Frequent UTIs mean poor hygiene.”	Anatomy, hormones, sex, and bladder factors are more important; prevention is individualized. auanet.org
“You still need a Pap every year.”	Most people need screening less often based on age and test type. Follow guidelines. uspreventiveservicestaskforce.org

Accessibility note
 We use “women” for brevity. We welcome and care for all people with vulvas/uteruses, including trans and non-binary patients. Tell us the words you prefer for your body.

FAQs

1) Is it okay to talk about sex with my family doctor?
 Yes. Primary care is trained to handle sexual health, screen for infections, manage pelvic floor issues, and coordinate referrals when needed.

2) Do I need a pelvic exam for every concern?
 Not always. Some issues can be discussed and triaged by telehealth; exams and swabs are offered when they will change care. You can ask to pause or stop at any time. cdc.gov

3) What does pelvic floor physical therapy involve?
 A therapist assesses muscle tone and coordination, then teaches tailored relaxation/strength skills, posture, and bowel/bladder strategies. Many people see steady gains over weeks with home practice. journals.lww.com

4) I’m in perimenopause/menopause and sex is painful. What helps?
 Vaginal moisturizers and lubricants help many. If GSM is present, low-dose vaginal estrogen is often effective; your clinician will review risks and preferences. PubMed

5) I keep getting UTIs. Can this be prevented?
 Yes—after confirming the diagnosis, options include behavior changes, patient-initiated treatment, and in menopause, vaginal estrogen; long-term antibiotics have pros/cons. Plans are individualized. auanet.org

6) Are there medicines for low desire?
 Sometimes. After evaluation, certain options exist for premenopausal women; off-label testosterone for postmenopausal HSDD may be considered with monitoring. Discuss benefits, side effects, and eligibility. ISSWSH

7) Will insurance cover this?
 Many plans cover an annual wellness visit and age-appropriate cervical screening. Coverage for tests, pelvic floor PT, and medications varies—our team can help you check before you start.

References

1. Sexually Transmitted Infections Treatment Guidelines, 2021 — CDC/MMWR, 2021. cdc.gov
   
2. Recurrent Uncomplicated Urinary Tract Infections in Women (Guideline; amended 2022) — American Urological Association, 2022. auanet.orgurology.wiki
   
3. Cervical Cancer Screening (Final Recommendation) — U.S. Preventive Services Task Force, 2018. Draft update on self-collection/HPV primary screening, 2024. uspreventiveservicestaskforce.org+1
   
4. Genitourinary Syndrome of Menopause Position Statement — The North American Menopause Society, 2020. PubMed
   
5. Female Sexual Dysfunction (Practice Bulletin) — American College of Obstetricians and Gynecologists, 2019. acog.org
   
6. ISSWSH Clinical Practice Guideline: Systemic Testosterone for HSDD in Women — J Sex Med, 2021. Oxford Academic
   
7. A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction — Obstet Gynecol, 2024. journals.lww.com
   
8. When Sex Is Painful (Patient FAQ) — ACOG, updated web resource (accessed 2025). acog.org

Disclaimer: This article is for informational purposes only and does not replace professional medical advice. Always consult a qualified healthcare provider before making health decisions.