Overview of dyspareunia
Dyspareunia refers to repeated pains felt in the pelvis or the genital area during sexual intercourse/coitus. The character of the pain is sharp or very intense and can happen at any point, before, during, or after coitus.
It occurs in both males and females although it is more severe in women. It can, however, be treated when the cause is known.
Causes of dyspareunia
There are many causes of dyspareunia. It may be due to a physical cause or even an emotional one.
The physical causes of dyspareunia include:
- Vaginal dryness following menopause, childbirth, breastfeeding, drugs, or too little foreplay to increase arousal before intercourse
- Skin problems that cause ulcers, cracks, itching, burning
- Urinary tract infections
- Trauma to the area as in childbirth, an accident, episiotomy (vaginal tear created surgically during childbirth to assist a difficult delivery), or a surgical procedure is done in the pelvis, hysterectomy (removal of the uterus)
- Inflammation of the vagina called vaginitis
- Pain concentrated in the vulva called vulvodynia
- Bladder inflammation is known as cystitis
- Pelvic inflammatory disease
- Uterine fibroids
- Irritable bowel syndrome
Painful intercourse can also be caused by some factors that affect a person’s ability to get aroused such as:
- Stress: exposure to stressful conditions will result in constricted pelvic floor muscles
- Sex-related fear, guilt or shame
- Body-image problems
- Medications such as contraceptives
- Relationship problems
- History of sexual abuse or rape
- Medical conditions such as diabetes, cancer, arthritis, and thyroid disease
Symptoms of dyspareunia
Pain during sex can occur under certain conditions such as:
- Site of occurrence: can occur in the vagina, urethra or bladder
- Time of occurrence: can occur before, during, or after intercourse
- Can occur with certain partners but not others
- Can occur when a tampon is used
- Can occur alongside itching, burning or aching
- Can mimic menstrual cramps when the pain is stabbing in character
Risk factors for painful intercourse
Dyspareunia causes pain and this can be felt by both men and women although it is commoner in women. It is a very frequent occurrence with post-menopausal women.
According to the American College of Obstetricians and Gynecologists, up to 75% of the women population will at some point in their life experience pain during sex. However, one is at an increased risk if they:
- Have infection caused either by bacteria or virus
- Take medications that result in vaginal dryness
- Are post-menopausal
Diagnosis of dyspareunia
Upon presentation to a doctor, a concise history would be taken covering both medical and sexual history. The questions you may be asked include:
- Where do you feel the pain?
- When do you feel the pain?
- Other than sexual intercourse, can any other activity cause the pain?
- Does your partner want to help?
- Are there other likely conditions that may be causing this pain?
- Are you exposed to a high amount of stress?
The doctor will go on to conduct a pelvic examination. Here, the external and internal pelvic area is examined to look out for:
- Signs of dryness such as cracks
- Anatomical abnormalities
- Genital warts
- Abnormal swellings
A device called a speculum would be employed during the internal examination. Also, a cotton swab may be used to exert pressure on different points of the vagina to determine the pain site.
Follow up tests may be requested after examination and they include:
- Pelvic ultrasound scan
- Culture tests to isolate bacteria
- Urine test
- Allergy test
- Counseling if an emotional cause is suspected
Treatment of dyspareunia
Dyspareunia is treated based on its cause. When the cause is an infection, drugs are used for the treatment. These drugs include:
- Antifungal drugs
- Steroids either in topical or injectable form
When these drugs are used for a long period, vaginal dryness can result and, in such cases, alternative medications are used to ensure a naturally lubricated, pain-free coitus.
Low levels of the hormone estrogen can also result in vaginal dryness. Estrogen supplementation or replacement in the form of tablets, cream, or flexible ring will help restore natural lubrication.
An alternative to estrogen replacement is a drug called ospemifene (osphena). It does not contain estrogen but it mimics the action of estrogen on vaginal tissue by increasing the thickness of the vaginal wall thereby making it less vulnerable to injury. This aids with pain relief during intercourse.
Other home remedies and lifestyle modifications help reduce the symptoms of dyspareunia and these include:
- Coitus when partners are relaxed
- Using water-based lubricants. Purchase water-soluble lubricants here.
- Tell your partner when you feel pain during intercourse
- Urinate before intercourse
- Have a warm bath before sex
- Take a pain reliever before sex. Find a selection of pain relievers online.
- Calm the burning vulva after sex by applying an icepack. Shop for ice packs.
Alternative remedies for painful intercourse
This has to do with psychotherapy. Sex therapy or desensitization therapy is the different modes used here.
In sex therapy, one is taught to improve communication with partners and maintain intimacy while desensitization therapy teaches vaginal relaxation techniques such as Kegel exercises that will help reduce pain.
Prevention of dyspareunia
There is no established way of preventing dyspareunia. However, the likelihood of painful intercourse is reduced by doing the following:
- Waiting for at least 6 weeks after birth before resuming intercourse
- Use a water-based lubricant to combat vaginal dryness
- Maintain good hygiene
- Prevent sexually transmitted diseases by making use of condoms and other barriers
- Create enough time for foreplay and stimulation to encourage natural vaginal lubrication
The main approach towards dyspareunia is finding the cause. Other intimacy techniques (such as kissing, oral sex, sensual massage, mutual masturbation) can be used by partners while addressing the cause of dyspareunia.