Dyspareunia - Causes, Symptoms & Treatment

Dyspareunia is painful sexual intercourse for women. It is not a disease, but rather a symptom of an underlying physical or psychological disorder. The pain may be located in the genitals or within the pelvis. Pain may be mild or severe, and it may very with different intercourse positions.Vaginal dryness can also cause painful sex. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus. Vaginismus is a spasm of the muscles around the vagina. In some women, the pain of the spasms is so severe that penile penetration is impossible. Numerous medical causes of dyspareunia exist, ranging from infections , endometriosis , tumors , xerosis (dryness, especially after the menopause ) and LSEA. Dyspareunia may result from female genital mutilation , when the introitus has become too small for normal penetration (often worsened by scarring). Psychologic factors can cause superficial or deep pain. Examples are anger or repulsion toward a sex partner, fear of intimacy or pregnancy, a negative self-image, and a traumatic sexual experience (including rape). However, psychologic factors may be difficult to identify. Negative attitudes about sex, misinformation about sex and misinformation about the functions of the woman's body are often associated with some types of pain. About 15% of women may have pain with intercourse at some point in their lives. About 12% have true dyspareunia. The incidence is much higher in women who have been raped or otherwise sexually abused. As stated, dyspareunia in men is rare and is almost always caused by a medical problem.

Women with dyspareunia were found to have more physical pathology on pelvic examination and greater psychological symptoms. Most common pain with dyspareunia occurs during coitus, but some women experience pain afterward, while others report pain at both times. Certain conditions or infections of the ovaries may also cause pain, especially in certain sexual positions. Past surgeries may leave scar tissue that can cause pain. Because the bladder and intestines are close to the vagina, they may also cause pain during sex. For men , the condition can result from such disorders as irritation of the skin of the penis due to an allergic rash; physical abnormalities of the penis, like a tight foreskin or a bowed erection; and infections of the prostate gland or testes. Symptoms include a burning, ripping, tearing, or aching sensation associated with penetration. The pain can be at the vaginal opening, deep in the pelvis, or anywhere between. Counseling is often helpful to identify and reframe negative feelings about sex. Couples therapy can help improve communication between partners and resolve problems that may be a factor in the sexual relationship. Sex therapy may be offered to provide information about the physical aspects of arousal and orgasm. Use of a vaginal lubricant, at least temporarily, may be helpful in some women to reduce anxiety about possible pain. Recommending a change in coital position to one admitting less penetration. Carefully examining the pelvis to duplicate as closely as possible the discomfort and to identify a site or source of the pelvic pain. Clearly explaining to the patient what has happened, including identifying the sites and causes of pain.

Causes of Dyspareunia

Common Causes and Risk factors of Dyspareunia

• Prior sexual trauma.
• Guilt, anxiety, or tension about sex.
• Prior physical trauma to the vaginal area.
• Depression.
• Vasocongestion.
• Female genital mutilation.
• Infections.
• Interstitial cystitis.

Signs and Symptoms of Dyspareunia

Sign and symptoms of Dyspareunia

• Burning.
• Ripping.
• Tearing, or aching sensation associated with penetration.
• Pain.
• Dryness of the vagina area.

Treatment for Dyspareunia

Common Treatment for Dyspareunia

• Medications are prescribed to treat infections. Alternative methods of contraception should be considered.
• Using alternate methods of birth control.
• Couples therapy can help improve communication between partners and resolve problems that may be a factor in the sexual relationship.
• Sex therapy may be offered to provide information about the physical aspects of arousal and orgasm.
• Use of a vaginal lubricant, at least temporarily, may be helpful in some women to reduce anxiety about possible pain.
• Recommending a change in coital position to one admitting less penetration
• Carefully examining the pelvis to duplicate as closely as possible the discomfort and to identify a site or source of the pelvic pain.
• Clearly explaining to the patient what has happened, including identifying the sites and causes of pain.
• Surgery may be needed to remove cysts or abscesses, open a rigid hymen, or repair an anatomic abnormality