Dyspareunia: De-Mystified

Dyspareunia: De-Mystified

One of the commonest problems faced by women is pain during sexual intercourse. Intercourse pain or dyspareunia, can cause problems in a couple's sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant.

Painful intercourse, described medically as dyspareunia, is not uncommon. An estimated 20 to 50 percent of women experience some form of sexual dysfunction, including pain during sex. "The term 'dyspareunia' means pain during sex, and it covers a huge category of symptoms, with a huge range of possible causes," says Edwin Huang, MD, a gynecologist at Massachusetts General Hospital in Boston. Those causes commonly range from, easily remedied issues such as allergic reactions or infections, to more complex, psychological issues.

For women, the symptoms of dyspareunia include pain in the vagina during sexual activity, either at the entrance of the vagina or further inside. Some women experience vaginismus, which means that their vaginal muscles involuntarily contract during penetration, making the experience painful. Dr. Huang says that some women with vaginismus not only have pain during sex, but they may also feel pain during routine gynecological exams.

You may feel pain in your vulva, in the area surrounding the opening of your vagina (called the vestibule), or within your vagina. The perineum is a common site of pain during sex. You also may feel pain in your lower back, pelvic region, uterus, or bladder.

In some cases, a woman can experience painful sex if one of the following conditions is present:

  • Vaginismus. This is a common condition. It involves an involuntary spasm in the vaginal muscles, mainly caused by fear of being hurt.

  • Vaginal infections. These conditions are common and include yeast infections.

  • Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.

  • Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.

  • Endometriosis. This is a condition in which the tissue that lines the uterus grows outside the uterus.

  • Problems with the ovaries. Problems might include cysts on the ovaries.

  • Pelvic inflammatory disease (PID). With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.

  • Ectopic pregnancy. This is a pregnancy in which a fertilized egg develops outside the uterus.

  • Menopause. With menopause, the vaginal lining can lose its normal moisture and become dry.

  • Intercourse too soon after surgery or childbirth.

  • Sexually transmitted diseases. These may include genital warts, herpes sores, or other STDs.

Injury to the vulva or vagina. These injuries may include a tear from childbirth or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.

Dyspareunia: De-Mystified

Some treatments for female sexual pain do require a doctor's care. If vaginal dryness is due to menopause, ask a health care professional about estrogen creams or other prescription medications. Other causes of painful intercourse may also require prescription drugs.

For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding past abuse.

Call a doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. Ask for a referral to a certified sex counselor if there are other concerns that need to be addressed.

Because there are so many possible causes of dyspareunia and vaginismus, Huang says, it is difficult to talk generally about treatment options. But, he says, "finding the source of the issues is more than half the battle." Huang says the first step for a doctor in treating dyspareunia is to compile a thorough and complete medical and sexual history of the patient, to identify possible causes. These could include:

Allergic reactions. The skin in the vagina can be irritated if you have an allergic reactions to a soap, detergent, a douche product, or perfumed tampons or maxi pads. Switch to unscented products with fewer ingredients if you suspect allergies may be involved Huang does not recommend douching because it can irritate the skin in the vagina.

Vaginal itching. Yeast infections, urinary tract infections (UTIs), and some sexual transmitted diseases cause itching and burning sensations in the vagina. Having sex while you are suffering from one of these conditions can be unpleasant and can cause dyspareunia. UTIs and yeast infections are treatable, and most sexually transmitted diseases can be treated or managed.

Dyspareunia: De-Mystified

Vaginal dryness. As many as 20 percent of women report lubrication difficulties, which can lead to pain during sex. The hormonal changes that accompany menopause can also lead to vaginal dryness. Huang says that using water-based lubricants and engaging in more foreplay before sexual intercourse can help with vaginal dryness.

Vaginismus. The involuntary contraction of vaginal muscles during penetration, or vaginismus, can be caused by physical and psychological factors, Huang says. Identifying the cause of vaginismus is essential for developing a treatment plan.

Though dyspareunia is often caused by easily treatable conditions, sometimes it can be a sign of more serious issues.

Health conditions. Sometimes, dyspareunia is a sign of other health conditions, including hemorrhoids or endometriosis, a condition in which the tissue that lines the uterus starts growing in other places in the body. All of these conditions are treatable.

Psychological causes. Psychological factors, such as anxiety and depression, can adversely affect sexuality and bring on dyspareunia. Women who have been sexually abused may find that their relationship to sex has changed dramatically. A sex therapist or counselor can help you address these root psychological causes and work with you to cultivate a healthy and positive sexuality.

Bottom line on sexual pain: Recognize your symptoms and seek advice. If you experience pain during intercourse, talk to your gynecologist. Sexual pain does not have to be part of your life.

Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.


Pain during penetration may be associated with a range of factors, including:

Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding.

Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.

Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).

Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.

Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

Congenital abnormality. A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.

Deep pain usually occurs with deep penetration and may be more pronounced with certain positions.


Dyspareunia: De-Mystified

Causes include:

Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.

Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy, can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain.

Emotional factors include:

Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.

Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.

History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.

Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.

Sexual response problems
: The following reasons are among the most common:

Your state of mind—
Emotions such as fear, guilt, shame, embarrassment, or awkwardness about having sex may make it hard to relax. When you cannot relax, arousal is difficult, and pain may result. Stress and fatigue can affect your desire to have sex.

Relationship problems—
Problems with your partner may interfere with your sexual response. A common relationship issue is a mismatch between partners in their level of desire for sex.

Many medications can reduce sexual desire, including some birth control methods. Many pain medications also can reduce sexual desire.

Medical and surgical conditions—
Some medical conditions can indirectly affect sexual response. These conditions include arthritis, diabetes, cancer, and thyroid conditions. Some women who have had surgery find that it affects their body image, which may decrease their desire for sex.
bIf your partner has a sexual problem, it can make you anxious about sex. If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, which can cause long, painful intercourse.

Gynecologic conditions can cause pain during sex

Pain during sexual intercourse can be a warning sign of many gynecologic conditions. Some of these conditions can lead to other problems if not treated:

Skin disorders—
Some skin disorders may result in ulcers or cracks in the skin of the vulva. Contact dermatitis is a common skin disorder that affects the vulva. It is a reaction to an irritating substance, such as perfumed soaps, douches, or lubricants. It may cause itching, burning, and pain. Treatment of skin disorders depends on the type of disorder.

This is a pain disorder that affects the vulva. When pain is confined to the vestibule (the area around the opening of the vagina), it is known as vulvar vestibulitis syndrome (VVS). There are many treatments available for vulvodynia, including self-care measures. Medication or surgery may be needed in some cases. For more information about this condition, see the FAQ Vulvodynia.

Hormonal changes—
During perimenopause and menopause, decreasing levels of the female hormone estrogen may cause vaginal dryness. Hormone therapy is one treatment option. Using a lubricant during sex or a vaginal moisturizer also may be helpful.


Dyspareunia: De-Mystified

Vaginitis, or inflammation of the vagina, can be caused by a yeast or bacterial infection. Symptoms are discharge and itching and burning of the vagina and vulva. Vaginitis can be treated with medication (see the FAQ Vaginitis).

Vaginismus is a reflex contraction (tightening) of the muscles at the opening of your vagina. Vaginismus may cause pain when you try to have sexual intercourse.

Vaginismus can be treated with different forms of therapy.

Women who have had an episiotomy or tears in the perineum during childbirth may have pain during sex that may last for several months. Treatments include physical therapy, medications, or surgery.

Other causes—
Pelvic inflammatory disease, endometriosis, and adhesions are all associated with pain during sex.

Your medical and sexual history, signs and symptoms, and findings from a physical exam are important factors in determining the cause of your pain. Sometimes, tests are needed to find the cause. A pelvic exam or ultrasound exam often gives clues about the causes of some kinds of pain. Further evaluation, sometimes involving a procedure called a laparoscopy, may be needed.

You also may be asked about medications that you are taking, whether you have any medical conditions, and past events that may affect how you feel about sex, such as sexual abuse. Other health care providers may be consulted for further evaluation and treatment, such as a physical therapist or a dermatologist (a specialist in diseases of the skin).

Things a woman can do on her own to help with pain during sex

If you have pain during sex, see a health care provider. However, there are some self-help measures you can try to relieve pain during sex:

  • Use a lubricant. Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.

  • Make time for sex. Set aside a time when neither you nor your partner is tired or anxious.
    Talk to your partner. Tell your partner where and when you feel pain, as well as what activities you find pleasurable.

  • Try sexual activities that do not cause pain. For example, if intercourse is painful, you and your partner may want to focus on oral sex or mutual masturbation.

  • Try nonsexual, but sensual, activities like massage.

  • Take pain-relieving steps before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse.

  • To relieve burning after intercourse, apply ice or a frozen gel pack wrapped in a small towel to the vulva.

If you have frequent or severe pain during sex, you should see a health care provider. It is important to rule out gynecologic conditions that may be causing your pain. Your health care provider also can help you address problems with sexual response.

Women Fitness hope the above resource shall go a long way in providing insight about Intercourse pain or dyspareunia to our viewers.



Dated 11 December 2015

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