We all anticipate occasional dry spells in our sex lives — it’s widely understood that stress, sleeplessness, new parenthood, and dissatisfaction with our bodies can hinder our pleasure.

But what if the reason you’re avoiding sex isn’t psychological, it’s physical.

There is an array of women’s health challenges that discreetly undermine sexual activity – and many women remain unaware of them. Those who do often feel too embarrassed to discuss it.

From unexplained pain during intercourse to fear of intimacy due to repeated infections, here are eight hidden conditions quietly affecting your sex drive.

YOU SURE IT’S JUST THRUSH?

‘I doubted myself at first, but it felt like my vaginal opening was getting smaller. I was ‘puffy’, swollen, and unbearably dry, yet my GP insisted it was thrush. During a smear test, the nurse couldn’t insert even the smallest speculum without causing severe pain and bleeding. It took years for a proper diagnosis.’

Vulval Lichen Sclerosus is often misdiagnosed as thrush so many women suffer for years without proper treatment.

This condition primarily impacts post-menopausal women, though it can occur at any age (and men and boys can experience it, too). It is a chronic skin condition, mostly affecting the genitals and the area around the anus, characterized by thinning, inflammation, and severe itching.

The skin becomes fragile and shiny, and you’ll see white patches. Without treatment, the vulva may gradually scar and shrink. This makes the entrance to the vagina narrower, with penetration becoming extremely painful or plain impossible.

Many women chalk it up to ‘just getting older’ or are too embarrassed to seek help.

How to treat it: See a GP or gynaecologist and insist on a referral, especially if you keep getting fobbed off with a thrust diagnosis. Treatment usually involves high-potency steroid creams that dramatically improve symptoms.

THE ULTIMATE MOOD KILLER

‘I’m 25 and have a high libido but every time my boyfriend makes a move, my heart sinks. I just know what I’m in for afterwards and it’s just not worth it.’

Post-Sex Urinary Tract Infections are staggeringly common. Some women suffer every single time they have sex, turning something they used to enjoy into a ticking time bomb.

Anticipating the familiar burn, pressure and panic sends the healthiest libido into lockdown. Many women stop having intercourse altogether.

How to treat it: There was some dispute over whether peeing before and after intercourse protects against UTI. 

But recent research points to it being helpful, so do it. A daily low-dose antibiotic is another way to control it, so is taking one just before sex to prevent recurrent infections. Some find D-Mannose supplements useful; using lube also helps. The more friction, the more risk you have of developing a UTI.

EVER HAD AN ACCIDENT DURING AN ORGASM?

‘It was the first night of sex with a guy I really cared about, soon after my divorce. The sex was great – but I lost control of my bladder during orgasm. I pretended it was female ejaculation, but it so wasn’t that. He knew it and I knew it. I could have died from embarrassment.’

Incontinence issues – loss of bladder control – is often due to pelvic floor damage from childbirth. Laughing, sneezing and sex can all trigger leaks.

Some women feel so mortified after an accident, they vow never to have sex again. Happily, there’s good news…

How to treat it: Kegel exercises – repetitively and regularly squeezing, holding and releasing your pelvic floor muscles – work. More effective though is pelvic floor physiotherapy. Yes, who knew there are physios for your pelvic floor? But they do exist and treatment is incredibly effective.

 There are also internal electrical stimulation devices that help. If it’s severe, there are also surgical options. Your GP won’t be shocked – they hear this daily. Speak up.

THE GHOST OF ONE-NIGHT-STANDS PAST

‘I got herpes when I was 24. I had horrific attacks for two years, then nothing for 15 years. It didn’t occur to me to tell my husband when I met him because I’d forgotten I even had it. Then, out of the blue – Bam! – a breakout. I was shocked. I’ve dodged advances from my husband since and he’s starting to get suspicious.’

Genital Herpes is a sexually transmitted infection that stays dormant in the body and can reappear years later during times of stress or illness.

Anyone who’s ever had herpes, knows it’s there forever. But it can appear to have gone away if you haven’t suffered for a very long time. An attack can happen, totally out of the blue, up to a decade later.

If you didn’t confess to your now partner – and most don’t unless it’s active and attacks are frequent – you now live in terror it will continue to return and they’ll find out. The stress of worrying about this happening can be enough to guarantee a recurrence.

What to do: Herpes is common – around one in six people have it. A frank, mature conversation is the best route. Most people don’t dump their partner once they confess to an STI got before they came along.

You can’t fix it but you can manage it. You can take an antiviral drug daily to suppress outbreaks if they’re regular. But if they’re few and far between, you’re better off just avoiding sex during that time.

The bottom line?

If sex hurts or fear, shame or discomfort are replacing pleasure, you need to speak up. Too many women silently suffer when most of these conditions are treatable. Your sex life is worth fighting for.

Start with a compassionate GP, ask for referrals to women’s health physios or gynaecologists and find online communities for support.

You’ll find Tracey’s products at lovehoney and her books wherever good books are sold. Submit a question for her weekly podcast, SexTok, at sextokpod.com.

FOUR MORE SILENT SEX SABOTEURS

The list continues…

VAGINISMUS is an involuntary tightening of the vaginal muscles which makes penetration extremely painful or impossible. Your body says no even if your brain says yes. It can be caused by trauma (past sexual or physical abuse, painful sex experiences) or negative beliefs about sex. 

Other times, there is no apparent reason. Lots of women feel ashamed or ‘broken’ and think there is no solution. 

The truth is, it’s a medical condition, not your fault, and highly treatable with pelvic floor physiotherapy, counselling and the use of vaginal dilators.

UNDIAGNOSED ENDOMETRIOSIS: I have two friends whose lives have been torn apart by this condition.

Endometriosis is a condition where tissue similar to the uterine lining grows where it shouldn’t. (My friend has it in her lungs.) Painful periods are a common side-effect but so is painful sex – especially if it’s deep penetration.

Diagnosis typically takes years: doctors are very keen to check off the more likely (and easier to treat) culprits of painful sex (like thrush, dryness, inadequate arousal). 

But keep pushing for scans, laparoscopy and hormonal treatments. All can help. Painful sex is NEVER normal. Demand answers.

CHRONIC THRUSH OR BV: The unwanted guests that never leave, recurrent thrush or bacterial vaginosis can lead to constant itching, burning and unpleasant discharge. 

It kills your sex life because you’re constantly uncomfortable, anxious about odour or embarrassed. If this is happening, don’t DIY with over-the-counter meds.

 Instead see a specialist. Often, it’s about restoring the vaginal microbiome – using probiotics and making dietary changes, as well as medical treatment.

UNHEALED EPISIOTOMIES: If you tore when your baby was born, there’s a chance it never fully healed or left scar tissue behind. 

The result is pain during sex, tightness and fear of re-tearing. Which means – yup! – women dreading intercourse. A specialist women’s health physio can help massage scar tissue and guide healing. There are also topical treatments