Dyspareunia is pain during sexual intercourse in women. It can be the entry or deep Dyspareunia. Women with a history of sexual abuse, pregnancy, infection in the vagina, or urinary tract pose the risk of Dyspareunia. There are treatment options according to the cause of the disease. Treatments are useful in reducing pain and managing Dyspareunia.(1)
Dyspareunia is a form of painful intercourse preventing or making penetration very difficult. In most cases, the pain has a psychological origin. Previous sexual abuse may play a role. Other causes include a rigid education presenting sexuality as something to be ashamed of, fear of sex, fear of pregnancy or panic of having children, brutality or lack of thoughtfulness of the partner, impotence, or anxiety of the partner which affects the woman.(1)
Who Is At Risk For Dyspareunia?
Certain women are more at risk of Dyspareunia. These include:
Psychological Issues: Psychological problems like depression or anxiety, concerning the physical appearance, problems with the relationships may lead to reduced sexual stimulation and subsequent pain at the time of intercourse.
Stress: In a stressed condition, the muscles of the pelvic floor get tightened and may cause pain during sex.
Previous Incidences Of Sexual Abuse: Dyspareunia may result from previous incidences of sexual abuse and harassment.
Other risk factors are breastfeeding, episiotomy, and any form of genital or perineal trauma.(3) (4)
Is There A Blood Test For Dyspareunia?
No blood test is required to diagnose dyspareunia. But dyspareunia may result from a bacterial or fungal infection that can be detected through blood tests. These tests include the detection of causative agents responsible for the urinary tract and vaginal infection.
Certain physical problems also cause the condition, such as incorrect placement of a diaphragm, genital prolapse, sequelae of defloration and difficult abortion, marked disproportion of the penis and vagina, scarring vaginal lesions (often, following childbirth), certain gynecological conditions, infection, endometriosis, fibroids; vaginal dryness due to hormonal hypo-secretion or lack of sexual stimulation, smegma (whitish, pasty substance, foul-smelling, located in the folds of the external genitalia), loss of vaginal elasticity after menopause. Further, ignorance of the anatomy and sexual functions can be at the origin of one or the other disorder.
The main symptoms are irritation and pain during intercourse. Other symptoms include vaginal dryness due to the lack of secretions usually produced during sexual stimulation to facilitate penetration. These secretions also decrease the acidity of the vagina to allow sperm to survive. Vaginal dryness is also associated with the absence of orgasm.
Different Types Of Pain Associated With Dyspareunia
There are usually two types of pain found in Dyspareunia:
- Entry dyspareunia, when pain occurs near or at the opening of the vagina,
- Deep dyspareunia, when it results in pelvic pain (pain felt in the pelvis region), including the lower abdomen and genital area.
There is another type of pain during sexual intercourse in women, known as Vaginismus. Some specialists consider Vaginismus as a special type of dyspareunia. It results in an involuntary contraction of the muscles of the perineum, which prevents entry during sexual intercourse.(2)
Physical causes must be treated medically. When the disorder is due to ignorance, the education of both partners is sufficient. But if the psychological causes dominate, the assistance of a marriage counselor or a psychotherapist is indicated, especially when the disorder is persisting for long.
In mild forms, soothing ointments, and the use of a light lubricant are very effective. Maintaining proper hygiene of the vaginal area is essential. When the vulva is inflamed, always keep it clean and dry.
In general, sexual intercourse should be discontinued until all inflammation, damage or irritation were reduced.
Medical advice is recommended in case of persistent, repeated, or severe dyspareunia. The treatment for dyspareunia depends on its origin such as:
- Psychotherapy, especially in cases of traumatic experiences
- Drug treatment, especially during gynecological infections
- Hormone replacement, especially during menopause
- A surgical treatment, particularly in the case of endometriosis.(5)
- Lee NM, Jakes AD, Lloyd J, Frodsham LC. Dyspareunia. Bmj. 2018;361:k2341.
- Rosen NO, Pukall C. Comparing the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain and dyspareunia. Sexual medicine reviews. 2016;4(2):126-135.
- Bertozzi S, Londero AP, Fruscalzo A, Driul L, Marchesoni D. Prevalence and risk factors for dyspareunia and unsatisfying sexual relationships in a cohort of primiparous and secondiparous women after 12 months postpartum. International Journal of Sexual Health. 2010;22(1):47-53.
- De Graaff A, Van Lankveld J, Smits L, Van Beek J, Dunselman G. Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. Human reproduction. 2016;31(11):2577-2586.
- Arthur B, Chung MK, Brobyn T, LaRiccia PJ. Successful Treatment of Dyspareunia with an Integrative Medicine Approach: A Case Report. Integrative Medicine. 2019;18(6):38-41.
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