What Are Common Causes Of Dyspareunia?

Dyspareunia is the sophisticated medical term that is used to describing painful sexual intercourse. The pain in genitals can be repetitive or continuous and may happen before, after or during the sexual act.

What Are Classic Symptoms Of Dyspareunia?

There are no medical tests to diagnose this disease. In other words, the diagnosis is generally made on the basis of physical symptoms; such as:

• Pain during penile penetration
• Pain while inserting tampon
• Severe pain while pushing
• Burning sensation
• Pounding pain which persists for hours after sexual intercourse
• Painful sex after previous painless sex

Common Causes Of Dyspareunia

Depending upon the type, there are numerous causative factors that may present with dyspareunia. The classification is made on the basis of type and onset of pain.

Pain At The Time Of Penetration

• Inadequate lubrication: Inadequate lubrication is one of the commonest cause of painful penetrations. It may be due to less foreplay or other physiological reasons such as menopause, lactation, or recent child birth. Besides this, there are certain medications which reduces the vaginal lubrication and lead to painful intercourse. For example, antihypertensive, antihistamines, antidepressants, sedatives, and few contraceptive pills.
• Infection, inflammation, or skin disorders: Infections in urinary or genital tract can lead to painful sex. Skin problems such as eczema in genital areas may also cause dyspareunia.
• Vaginismus: The involuntary tightening or spam of vaginal muscles can make penetrations painful.
• Trauma or irritation: Irritation or trauma due to pelvic surgery, accident, female circumcision, or episiotomy (incision during child delivery for enlarging the birth canal) also leads to it.
• Congenital abnormality: Some women are born with abnormalities such as imperforate hymen (a membrane blocking vaginal mouth) and vaginal agenesis (lack of properly developed vagina).

Deep Pain During The Act Of Intercourse

• Surgeries or Medical treatment: Certain pelvic surgeries such as hysterectomy produces scars, which may cause discomfort during sex. Cancer treatments such as chemotherapy and radiations also induces changes that lead to painful sex.
• Diseases: There are certain disease conditions which causes dyspareunia, including:

• Uterine prolapse
• Pelvic inflammatory disease(PID)

• Endometriosis
• Cystitis
• Uterine fibroids
• Retroverted uterus
• Ovarian cysts
• Hemorrhoids
• irritable bowel syndrome

Emotional Factors

• Psychological issues: Depression, anxiety, low self-esteem, and intimacy issues lower the libido, leading to dyspareunia.
• Stress: The muscles of pelvic floor become tight in response to stress, thus making sex difficult and painful.
• Sexual abuse: Women who had been sexually abused in past, usually suffer through dyspareunia.

Treatment

• Terminating medications that causes vaginal dryness is often helpful at managing dyspareunia.
• If dyspareunia is secondary to infections or other diseases, treating them will resolve the issue.
• Topical estrogen is beneficial when this disease occurs after menopause, as estrogen drops down leading to less lubrication.
• Osphena (ospemifene) is an FDA-Cleared drug that is used to treat moderate to severe dyspareunia due to inadequate lubrication. It mimics estrogen in activity but does not have estrogen like adverse effects.
• Desensitization therapy is another option, involving exercises that allows vaginal muscles to relax, thus easing the pain.
• Prolonged dyspareunia results into lack of emotional connection and intimacy with your partner. You may not respond to sexual stimuli even after treatment. In such case, consult a sex therapist or counselor.

Changing Sexual Habits

Talk to your partner and explore different sex positons which are less painful. Usually women have more control and feel lesser pain when they are at top. Moreover, use lubricants and extend foreplay for sufficient lubrication.

References

• Seehusen, D. A., Baird, D. C., & Bode, D. V. (2014). Dyspareunia in women. Am Fam Physician, 90(7), 465-470.
• Krapf, J. M., & Goldstein, A. T. (2016). Diagnosis and Management of Sexual Pain Disorders: Dyspareunia. In Management of Sexual Dysfunction in Men and Women (pp. 287-305). Springer New York.
• Leeners, B., Hengartner, M. P., Ajdacic-Gross, V., Rössler, W., & Angst, J. (2015). Dyspareunia in the context of psychopathology, personality traits, and coping resources: results from a prospective longitudinal cohort study from age 30 to 50. Archives of sexual behavior, 44(6), 1551-1560.