Dyspareunia: What You Need to Know About Painful Intercourse
Dyspareunia is a medical term that refers to persistent or recurrent pain in the genital area or within the pelvis during sexual intercourse. It can affect both men and women, but it is more common in women. Dyspareunia can have various causes, ranging from physical to psychological, and it can interfere with sexual satisfaction and intimacy.
Causes of Dyspareunia
Some of the possible physical causes of dyspareunia include:
- Vaginal dryness, which can result from hormonal changes due to menopause, childbirth, breastfeeding, medications, or insufficient arousal before intercourse.
- Skin disorders, such as eczema, psoriasis, or lichen sclerosus, can cause ulcers, cracks, itching, or burning in the genital area.
- Infections, such as yeast infections or urinary tract infections (UTIs), that can cause inflammation, irritation, or discharge in the vagina or urethra.
- Injury or trauma, such as from childbirth, an accident, an episiotomy (a surgical cut made during delivery), a hysterectomy (surgical removal of the uterus), or pelvic surgery.
- Vulvodynia, which is a chronic pain condition that affects the vulva (the external female genitalia) and has no clear cause.
- Vaginismus, which is a condition that causes involuntary spasms of the muscles of the vaginal wall, making penetration difficult or impossible.
- Endometriosis, which is a condition where the tissue that normally lines the inside of the uterus grows outside of it, causing pain and inflammation in the pelvic organs.
- Cystitis, which is an inflammation of the bladder that can cause pain during urination and intercourse.
- Pelvic inflammatory disease (PID), which is an infection of the female reproductive organs that can cause pelvic pain, fever, and abnormal vaginal discharge.
- Uterine fibroids, which are noncancerous growths in the wall of the uterus that can cause heavy bleeding, pressure, and pain in the pelvis.
- Irritable bowel syndrome (IBS), which is a disorder that affects the large intestine and can cause abdominal cramps, bloating, gas, diarrhoea, or constipation.
Some of the possible psychological causes of dyspareunia include:
- Stress, which can affect sexual desire and arousal and cause muscle tension in the pelvic floor.
- Fear, guilt, or shame related to sex, which can stem from cultural or religious beliefs, past sexual abuse or trauma, or negative sexual experiences.
- Self-image or body issues, which can affect confidence and comfort during sex.
- Medications, such as antidepressants, high blood pressure drugs, sedatives, antihistamines, or birth control pills, which can affect libido and sexual function.
- Relationship problems, such as lack of trust, communication, or intimacy with a partner.
- History of sexual abuse or rape.
Symptoms of Dyspareunia
The pain associated with dyspareunia can vary depending on the cause and location. It can occur:
- In the vagina, urethra, or bladder during penetration
- During or after intercourse
- Deep in the pelvis during intercourse
- After pain-free intercourse
- Only with specific partners or circumstances
- With tampon use
- Along with burning, itching, or aching
- With a feeling of stabbing pain similar to menstrual cramps
Diagnosis of Dyspareunia
If you experience recurrent pain during sex that affects your quality of life and relationship with your partner, you should see your doctor for a diagnosis. Your doctor will start by taking a complete medical and sexual history, asking you about your symptoms, when they started, how often they occur, what triggers them, and how they affect you emotionally and physically.
Your doctor will also perform a physical examination, including a pelvic exam, to check for any signs of infection, inflammation, injury, or abnormality in your genital area. Your doctor may also take samples of your vaginal discharge or urine for laboratory testing to rule out any infections.
Depending on your symptoms and medical history, your doctor may also order other tests, such as:
- Blood tests to check your hormone levels
- Ultrasound to look for any abnormalities in your pelvic organs
- Laparoscopy to examine your pelvic cavity with a small camera inserted through a tiny incision in your abdomen
- Hysteroscopy to inspect your uterus with a thin instrument inserted through your cervix
- Biopsy to take a small tissue sample from your vulva or cervix for microscopic analysis
Treatment of Dyspareunia
The treatment of dyspareunia depends on the underlying cause and may involve medication, surgery, or nonmedical approaches.
Some of the possible treatments include:
- Lubricants, which can help reduce friction and dryness during intercourse. You should use water-based or silicone-based lubricants that are compatible with condoms and do not contain alcohol, glycerin, or parabens, which can irritate the vaginal tissue.
- oestrogen therapy, which can help restore vaginal moisture and elasticity in postmenopausal women or women who have low oestrogen levels due to other causes. Oestrogen therapy can be administered as a cream, tablet, ring, or patch that is applied to the vagina or the skin.
- Antibiotics, antifungals, or antivirals, which can treat infections that cause dyspareunia, such as UTIs, yeast infections, or herpes.
- Pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, which can help ease pain and inflammation associated with dyspareunia. However, you should not use these drugs for long-term relief without consulting your doctor.
- Hormonal birth control, which can help regulate your menstrual cycle and reduce pain caused by endometriosis or uterine fibroids. However, some types of hormonal birth control can also cause vaginal dryness and low libido as side effects.
- Surgery, which can remove or reduce the size of uterine fibroids, endometrial tissue, ovarian cysts, or scar tissue that cause dyspareunia. Surgery can also correct structural problems such as a narrow vagina or an imperforate hymen.
- Pelvic floor physical therapy, which can help relax and strengthen the muscles of the pelvic floor that may be tight or weak due to vaginismus, vulvodynia, childbirth, or surgery. Pelvic floor physical therapy may involve exercises, massage, biofeedback, electrical stimulation, or dilators.
- Psychotherapy or sex therapy, which can help address the emotional and psychological factors that contribute to dyspareunia, such as stress, anxiety, depression, trauma, self-esteem issues, or relationship problems. Psychotherapy or sex therapy can help you cope with your feelings, communicate with your partner, and enhance your sexual satisfaction.
Prevention of Dyspareunia
Some cases of dyspareunia may not be preventable, but you can take some steps to reduce your risk and improve your sexual health, such as:
- Practising good hygiene and avoiding irritants that can cause infections or inflammation in your genital area
- Using condoms and getting tested regularly for sexually transmitted infections (STIs)
- Having regular pelvic exams and Pap tests to screen for any abnormalities in your reproductive organs
- Using lubricants during intercourse if you experience vaginal dryness
- Engaging in adequate foreplay and arousal before intercourse
- Choosing comfortable sexual positions that do not cause pain
- Communicating with your partner about your preferences, needs, and boundaries during sex
- Seeking professional help if you have any medical, emotional, or relationship issues that affect your sex life
Outlook for Dyspareunia
Dyspareunia is a common condition that can affect anyone at any age. It can have a negative impact on your quality of life and relationship with your partner, but it is treatable. With proper diagnosis and treatment, you can overcome dyspareunia and enjoy a fulfilling sex life.
Sources
[1] Mayo Clinic. (2020). Painful intercourse (dyspareunia): https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
[2] Healthline. (2019). Dyspareunia (Painful Intercourse): Causes,
Treatments, and More: https://www.healthline.com/health/dyspareunia
[3] MSN. (n.d.). What is Dyspareunia and its causes and related conditions? https://www.msn.com/en-us/health/symptoms/Dyspareunia/hp-dyspareunia