1. Vaginal Discharge
“When you ovulate in the middle of your menstrual cycle and your body is most fertile, your vagina secretes clear to slightly cloudy fluid that is more copious than at other times of the month,” says Sandra Reed, MD, a spokeswoman for the American Congress of Obstetricians and Gynecologists who is based in Thomasville, GA. While this type of vaginal discharge is perfectly healthy, other types are cause for concern. For example, if the fluid is clotted, clumpy and white, like cottage cheese, the problem is likely a yeast infection. This is the result of an overgrowth of a fungus called candida, which is always present in the vagina. Stress, illness, taking drugs like antibiotics and steroids, and sometimes, health problems such as diabetes can cause the overgrowth. Yeast infections affect three out of four women at some point in their lives, and can be passed between sexual partners if not treated immediately. Vaginal discharge can also signal a sexually transmitted infection (STI), including gonorrhea (marked by greenish-yellow fluid), trichomoniasis (in which the discharge is usually frothy), or Chlamydia (which can cause excessive, clear-to-white discharge). “Make sure to treat STIs right away, as they can be dangerous for you and your partner, especially if they spread and their symptoms worsen,” says Leandro Mena, MD, an infectious disease specialist at the University of Mississippi Medical Center in Jackson and a spokesman for the American Social Health Association.
2. Itchy Rash
If your genital area is inflamed and itchy, you likely have some form of vulval dermatitis, which is an allergic reaction to an irritant that could be anything from shower gel to synthetic underwear fibers. “Sometimes rashes manifest after sex because women may be allergic to latex condoms, lubricants or spermicidal creams,” says Dr. Curtis. “They can even be allergic to their partner’s urine, sweat or sperm.” A rash could also signal herpes, an STI causing sporadic outbreaks that usually begin with a tingling sensation and then erupt into small red bumps or white blisters. “Herpes affects 16 percent of people, but 80 percent of carriers don’t realize they have it because they have no visible signs, and symptoms can vary from person to person,” says Dr. Mena. “If you or your partner has herpes symptoms, abstain from intercourse and see your doctor right away.” It’s crucial for pregnant women to get herpes treatment because they can transmit the infection to infants during childbirth. It’s also important to get continued treatment to prevent or minimize future herpes outbreaks; herpes is most contagious during visible outbreaks, even though those outbreaks may change and become less severe over time. Another possible cause of itchy rash is lichen sclerosus, a rare skin condition that causes patchy white skin mostly on the genital and anal areas. The condition causes skin on those areas to thin out and tear more easily, sometimes leading to scarring. Prompt diagnosis and treatment (usually with cortisone creams and ointments) is essential. Left unchecked, lichen sclerosus can cause the genitals to become malformed, making it painful to have sex and difficult to urinate.
3. Burning Sensation
If you need to urinate with alarming frequency and it’s extremely painful, bacteria, in the form of a urinary tract infection, might be to blame. “Frequent intercourse can boost your risk of UTIs, and can increase the pain that they cause,” says Dr. Curtis. “Sex can also move the infection up to your bladder, causing a more serious infection called cystitis.” In rare cases, burning sensations are a sign of vulvodynia, chronic pain in the vulva that can be caused by infection (such as repeated yeast or candida outbreaks), trauma (such as pelvic surgery that damages the nerves and causes them to feel continued pain) or an unidentifiable trigger. This condition, which affects 1 percent of U.S. women, can cause pain not just during sex but also while a woman is walking, using the bathroom or even just resting. Most often, vulvodynia is treated with medication, biofeedback therapy or local anesthetics. In some cases where localized vulvodynia is present surgery is performed as a last resort to remove inflamed nerves.
4. Muscle Spasms
Do your genitals regularly clench or clamp down when you’re touched or trying to have sex? If so, Dr. Reed points to vaginismus as the most likely cause. Vaginismus affects 6 percent of women and causes involuntary spasms of the vaginal wall muscles, making penetration painful. Dr. Reed says the cause of such spasms and pain is not fully known—and sometimes there is no identifiable cause. Most often, however, the root of the condition is emotional, such as past sexual trauma or anxiety about intercourse. Treatment can involve counseling, the use of vaginal dilators and physical therapy to retrain muscles and prevent them from spasming during sex.
5. Sour Smell
If your usual scent turns fishy or sour, that’s a telltale sign of bacterial vaginosis (BV), an inflammation resulting from the overgrowth of bacteria (usually gardnerella) normally found in the vagina. “Smoking, frequent douching and frequent sexual activity can all trigger BV,” says Dr. Curtis. Women usually notice BV’s smell most strongly right after their period or after sex. Treatment typically involves a course of antibiotic medication. In rare cases, a foul smell may be caused by a tampon that is left in the vagina longer than the recommended eight hours to prevent bacterial infection and toxic shock syndrome (a severe disease caused by staph bacteria). “If you’ve left your tampon in for more than a day, you may need to see your MD to remove it and get medication to treat infection,” says Dr. Reed. She adds that leaving in a tampon for a few extra hours will not likely cause toxic shock syndrome, however if you do and are experiencing a high fever, contact your doctor immediately.
The cause of spotting or light bleeding can be traced to varying factors depending on your age and health. Menopause or a hormonal imbalance can cause your uterus to shed blood and tissue at unexpected times, leading to spotting. Light bleeding can also happen if you’re using a brand of birth control pill that doesn’t agree with your body; it can cause your uterine lining to shed before the phase when you take placebo pills. If bleeding only happens right after sex—and not at any other time—Dr. Curtis says it could be an issue with your cervix. “The cells there may be sensitive or inflamed for some reason, such as an HPV infection or even the beginnings of cervical cancer.” Other causes of vaginal bleeding could include endometrial cancer, uterine fibroids (which are benign growths), pelvic inflammatory disease (bacterial infection that spreads to the upper genital tract) or an ectopic pregnancy (which takes root in the fallopian tubes instead of the uterus). If you’re pregnant, bleeding could be a sign of a miscarriage. If that’s the case, Dr. Reed recommends calling your doctor and heading to the emergency room right away.
7. Pain During Sex
Nearly 22 percent of women experience dyspareunia, or painful intercourse, at some point in their lives, reports the World Health Organization. The cause is usually a matter of physics—a need to avoid deep thrusting or finding a position that’s pleasurable for you. If pain persists, there could be many causes: ovarian cysts, infections of the uterus or fallopian tubes, scar tissue from old infections or surgeries, endometriosis (in which menstrual tissue grows in the abdominal cavity) or fibroids (benign uterine growths). If you experience any sustained pain when you have sex, talk with your physician. “Pay attention to where the pain is,” says Dr. Curtis. “Note whether it’s sharp or dull, constant or sporadic, and describe it in detail to your doctor.”