Dyspareunia is a condition where the person feels pain during intercourse. There are many causes for painful intercourse. It can be due to psychological issues or structural problems. Many women especially, experience painful intercourse at some time in their life. Dyspareunia is the medical term used for painful intercourse. It is defined as recurrent or persistent genital pain which occurs before, during or after the act of sexual intercourse.
Treatment aims at treating the underlying cause.
Causes of Dyspareunia or Pain during Sex
There are different physical causes of dyspareunia or pain during sex. It depends on when the pain is felt, at entry or with deep thrusting. Dyspareunia or Painful intercourse can also be associated with various emotional factors.
Pain during Entry
Dyspareunia or pain occurring during penetration can be due to various factors, including:
- Trauma, injury or irritation such as occurring from pelvic surgery, accident, female circumcision or episiotomy which is a cut made during childbirth for enlarging the birth canal.
- Insufficient lubrication often occurs as a result from insufficient foreplay causing dyspareunia or pain during sex. Decrease in lubrication also occurs from decrease in the level of estrogen after childbirth, after menopause or during breast-feeding.
- There are certain medications which inhibit or decrease arousal or the desire which in turns decrease the lubrication resulting in dyspareunia or painful intercourse.
- These medications include high blood pressure medications, antidepressants, sedatives, certain birth control pills and antihistamines.
- Infection, inflammation or skin disorder in the genital region or urinary tract can lead to dyspareunia or pain during sex. Skin problems, such as eczema in the genital area can also cause problems.
- Vaginismus is a condition where there is involuntary muscle spasm of the vaginal wall thus making penetration very painful resulting in dyspareunia or pain during sex.
- Congenital abnormality, such as vaginal agenesis, which is absence of a fully-formed vagina or another condition, such as imperforate hymen where there is development of a membrane which blocks the opening of the vagina; all these factors can cause dyspareunia or painful intercourse.
This is felt usually with deep penetration and can aggravate with some positions. Some of the causes of deep pain include:
- Certain conditions and illnesses, such as pelvic inflammatory disease, uterine prolapse, endometriosis, uterine fibroids, ovarian cysts, retroverted uterus, irritable bowel syndrome, cystitis and hemorrhoids.
- Medical treatments or surgeries where scarring can occur from pelvic surgery, including hysterectomy, which can sometimes lead to dyspareunia or pain during sex. Certain medical treatments, such as radiation and chemotherapy for cancer lead to changes which makes sex painful.
Emotional Factors as a Cause for Dyspareunia or Pain during Sex
Not many people are aware of it, but emotions are deeply related with sexual activity and can also play a role in dyspareunia. Some of the emotional factors are:
- Psychological problems, such as depression, anxiety, concerns about physical appearance, fear of relationship or intimacy lead to decreased level of arousal which results in discomfort or pain during sex.
- Stress causes tightening of the pelvic floor muscles, which can cause pain during intercourse.
- History of sexual abuse can play a role in causing dyspareunia.
In some cases, it is difficult to tell if the psychological factors are the cause of dyspareunia, as the initial pain causes fear of recurring pain which makes it difficult to relax resulting in more pain. Just like any pain in the body, a person may avoid activities (in this case intercourse) which are associated with the pain.
Signs & Symptoms of Dyspareunia of Pain during Sex
- Pain is felt only during entry or sexual penetration.
- The other symptom of dyspareunia or pain during sex is pain is felt with every penetration, even when inserting a tampon.
- Deep pain is felt during thrusting.
- New pain is experienced when the patient has had a previously pain-free intercourse.
- Aching pain or burning pain.
- Throbbing pain is felt which lasts for many hours after the intercourse can also be a symptom of dyspareunia or painful intercourse.
Investigations to Diagnose Dyspareunia
- A thorough medical history of the patient is taken where the patient is asked questions, such as the time when the pain started, where the patient is feeling pain, if the pain is present for every sexual position. Questions are also asked about patient’s sexual history, surgical history and previous experiences of childbirth. Patients should not get embarrassed and answer the questions to the best of their ability and the answers to these questions will help in identifying the root cause of the pain during sex.
- A pelvic exam is also done where the doctor checks for any signs of skin infection, irritation, or anatomical problems. The doctor may also try to identify the location of the pain by gently pressing on the pelvic muscles and the genitals.
- Visual exam of the vagina is also done using a speculum, which is an instrument which helps in separating the vaginal walls. Patients who have pain during sex can also feel pain during the pelvic exam.
- Pelvic ultrasound is also done to identify other causes of pain during sex.
Treatment for Dyspareunia or Pain during Sex
Treatment depends on the cause of dyspareunia or pain during sex.
Medications for Dyspareunia or Pain during Sex
- If the cause of dyspareunia is any medical condition or an infection then treating the underlying cause helps in resolving the pain. Some medications cause decrease in lubrication so changing these medications can help in eliminating the symptoms.
- Dyspareunia in most postmenopausal women occurs as a result of inadequate lubrication due to low estrogen levels. Treatment for this is done by prescribing topical estrogen which should be applied directly to the vagina.
- The drug ospemifene is a recently approved drug by the FDA for helping in treatment of moderate to severe dyspareunia in patients where vaginal lubrication is the problem. The action of ospemifene is just like estrogen on the vaginal lining, but it does not carry the potentially harmful effects of the estrogen on the breasts or the uterine lining (endometrium). However, this medicine is expensive and has side effects such as hot flashes, increased risk of blood clots and stroke.
Types of Therapy for Dyspareunia or Pain during Sex
- Desensitization therapy is where the patient is taught vaginal relaxation exercises, which help in decreasing the pain. Kegel exercises are also recommended which strengthen the pelvic floor. Other techniques are also taught to help relieve pain during sex.
- Sex therapy or counseling can be done, especially if the intercourse has been painful for a long period of time, as the patient can experience a negative emotional response to sexual stimulation even after treatment is done. If the patient and her partner have avoided intimacy due to painful intercourse, then it is important to improve communication with each other to try and restore the sexual intimacy. Sex counseling can help in resolving these problems. CBT or cognitive behavioral therapy also helps in changing the negative behaviors or thought patterns.
Lifestyle Modifications for Dyspareunia
By making some changes to the sexual routine, dyspareunia or the pain of intercourse can be reduced. The changes comprise of:
- Switching sex positions helps in minimizing dyspareunia. If the patient is having sharp pain during thrusting, then it could be that the penis is stressing the muscles of the pelvic floor or striking the cervix resulting in aching or cramping pain. Changing the positions can help in such a situation.
- Communication is important. Talk to each other about what feels good and what doesn’t; it helps in foreplay and lubrication and reduces the pain in sexual intercourse. If your partner is going too fast, then communicate with him and tell him so.
- Try to prolong the foreplay as it helps in stimulating the natural lubrication. Pain can also be reduced by delaying the penetration until full arousal is achieved.
- Using lubricants can help in making the sex more comfortable. Different brands can be tried until you find the one which is well suited to your needs.