Dyspareunia

Dyspareunia is pain in the vagina when the penis is inserted during sexual intercourse.

What is going on in the body?

Pain during sexual intercourse can be upsetting. The cause of the pain may be hard to find. There might be physical and psychological causes.

Physical causes may be within the female reproductive tract, including the vulva, vagina, cervix, uterus, Fallopian tubes, ovaries and abdominal cavity.

Some women may assume that sex will be painful. Or they might associate menstruation and childbirth with pain. Even when no physical causes are found and the pain is gone, the memory of the pain may persist. This can interfere with pleasure. The range of physical and psychological factors that prevent a woman from enjoying a sexual relationship should be considered.

What are the causes and risks of the condition?

Complications involving the vaginal opening that can cause dyspareunia can include:

no opening in the hymen.

after childbirth, a pain at site of the episiotomy, the incision made to enlarge the vaginal opening.

inflammation of the vagina, or vaginitis.

cyst or abscess.

infection of sweat or mucus glands.

Complications involving the clitoris can include:

irritations, inflammation.

infections.

abrasions due to trauma, bike riding, recent intercourse, etc.

Complications involving the vagina can include:

infections.

sensitivity to medications, spermicides.

vaginal inflammation after birth or during menopause

decreased lubrication, due to menopause, partner impatience, not enough foreplay

Complications involving the uterus and Fallopian tubes leading to the ovaries can include:

endometriosis, where tissue from the uterine lining travels outside the uterus.

endometritis, or infection of the uterus.

ectopic pregnancy, which is a pregnancy outside the uterus.

pelvic inflammatory disease (PID).

pelvic adhesions or scar tissue from previous abdominal surgeries.

Complications involving the ovaries can include:

cysts.

endometriomas, or cancers involving uterine lining tissue .

adhesions, or scar tissue from previous surgery or infection.

Psychological complications can include a history of:

incest

sexual abuse

physical abuse

post-traumatic stress syndrome.

emotional abuse

alcohol dependence.

substance abuse.

cultural-religious inhibitions.

What are the signs and symptoms of the condition?

Dyspareunia may be divided into two categories, superficial and deep. Superficial means that there is immediate pain at the opening of the vagina when a man attempts to insert the penis. The most likely reasons for this are tears, infections or structural defects of the vulva or vagina.

Deep dyspareunia means that there is pelvic pain or discomfort after penetration of the penis. This is usually associated with deep thrusting. The likely causes are abnormalities of the deeper structures of the vagina.Typical symptoms include:

immediate vaginal pain with attempted penile or finger penetration.

poor lubrication.

tearing sensation of the vulva or vagina.

deep pain or cramping with pelvic thrusts.

nausea with deep thrusts.

rectal pressure, pain with sexual intercourse.

muscle spasms that anticipate vaginal penetration.

How is the condition diagnosed?

A medical history and pelvic examination will help to determine the cause of dyspareunia. The following tests or procedures may be used:

visual inspection and touching of the reproductive organs.

cervical cultures to rule out infections.

ultrasound.

laparoscopy.

What can be done to prevent the condition?

Prevention depends on the cause. Using safer sex practices will prevent the transmission of sexually transmitted disease (STDs). This may prevent other complications. Sensitivity foreplay and patience will allow for more vaginal lubrication. If estrogen levels are low, estrogen supplements may help. Psychological causes for sexual inhibitions should be explored and treated.

What are the long-term effects of the condition?

The long-term effects rely on breaking or preventing a cycle of pain, negative memories, and avoiding sex. This cycle may destroy a sexually intimate relationship.

If other physical problems exist, diagnosis and treatment may prevent long-term complications.

What are the risks to others?

Dyspareunia is not a contagious condition. If the cause of dyspareunia is an untreated STD, there is a risk of spreading the disease to a partner.

What are the treatments for the condition?

Sensitivity, foreplay and patience from the sexual partner will allow for more lubrication of the vagina. If estrogen deficiency is the cause vaginal estrogen creams, such as estropiate or estradiol creams, may prevent small cuts. Psychological evaluation for sexual inhibitions/sexual trauma should be checked and treated. Antibiotics, such as sulfamethoxazole/trimethoprim, are used for infections.

Endometriosis is treated with birth control pills, progestins, which are female hormones, gonadotropin agonists, which counter the effect of certain hormones, and laser surgery. If an ectopic pregnancy or severe endometriosis is found, immediate surgery is needed. For the woman with severe vaginismus, or involuntary contraction of the vaginal muscles when touched, a program of gradual vaginal expansion is needed. Dilators, the woman’s fingers or the partner’s fingers along with psychotherapy may be helpful.

What are the side effects of the treatments?

Side effects depend upon the treatment used. Oral contraceptives and progestins may cause nausea, abdominal bloating, weight gain and swelling. Antibiotics have individual side effects. Gonadotropin agonists may cause hot flashes, headaches, lack of menstrual periods and mood swings.

How is the condition monitored?

The healthcare provider must be patient and explain the many causes of dyspareunia. The treatment options must be made clear. If there are no physical causes, a psychological reason should be explored. Reasons may include previous sexual abuse, confusion over sexual preference and desire, dissatisfaction with the relationship and depression.