Dispareunia

What is Dyspareunia?

Dyspareunia is described by medical people as any kind of pain experienced during sexual intercourse, generally by the female partner.

Since this pain is primarily associated with the female, it is generally felt in the areas of the clitoris, labia or vagina. Dyspareunia is commonly experienced during penetration, although it can persist throughout the intercourse episode, and even for a while afterward. Females who have been through this kind of pain have described it variously as stinging, cramping, burning, or as a sharp pain similar to a muscle pull.

Dyspareunia is often closely associated with vaginismus, which is an involuntary tightening of the vagina, often brought on by anxiety or stress. In this kind of muscle tightening, penetration can become very difficult and painful for the female, and it may even be downright impossible.

From this close association, it should not be understood that the two terms are equivalent, since vaginismus (muscle tightening) can lead to any of the possible forms of dyspareunia (sexual discomfort or pain). There are many more causes of dyspareunia than anxiety, including many physical causes described below. The two conditions are however, often closely related, and are commonly experienced during the same episode of intercourse.

Symptoms of dyspareunia

It may sound like the symptoms of dyspareunia are fairly straightforward, i.e. vaginal discomfort and pain during sexual intercourse, but it generally does take an examination by a trusted physician to make that determination.

One reason for this is that pain in the area of the genitals can be caused by many other things besides dyspareunia, so before a doctor will diagnose dyspareunia, he/she will more than likely interview you, and want to perform some tests.

For example, you would probably be asked questions like these, as well as several others:

  • Can you describe this pain in terms of its intensity and exactly where it’s located?
  • When did you begin experiencing this kind of discomfort (not the date, but the situation)?
  • Have you tried to relieve the pain yourself, and if so, by what specific measures?
  • Have you made use of a sexual lubricant, or have you made an effort to extend foreplay before engaging in intercourse?
  • Do you experience pain every single time you have sex with your partner?
  • Do you have any other problems which occur while you are engaged in sexual intercourse?

It’s very possible that your doctor will want to conduct a pelvic exam, in which a cotton-tipped swab is applied to the vaginal area to see whether or not it’s painful for you. A speculum may be used by the doctor to examine your vagina and cervix, by gently opening the area so the examination can proceed. This kind of examination is quite similar to a Pap smear, and may be somewhat painful, because of the speculum usage.

To complete the pelvic exam, your doctor will feel your ovaries and uterus, holding one hand on your abdomen while inserting fingers in your vagina. If this test yields results that suggest some kind of infection, it’s likely that your doctor will secure a sample from your cervix or vagina for analysis at a laboratory.

A urine test might also be taken, or a pelvic sonogram, a computed tomography test, or an X-Ray, which can provide an internal look at your pelvis. Once your doctor has performed all tests which he feels might be relevant to the situation, and has considered your responses to the interview questions, he/she should be able to tell you whether your symptoms are indicative of dyspareunia, or whether your pain is due to some other physical/medical cause.

Dyspareunia causes

There are a number of causes for dyspareunia, most of them being physical causes, with a few having a psychological component as well.

Many of the causes of dyspareunia are traceable to very common physical problems, such as an inflammation of the vagina. This can be so uncomfortable that any kind of underclothing can be severely irritating, and can actually cause pain.

Muscle spasms around the area of the vagina can be moderate to severe, and in some cases the spasms can be so intense that sexual intercourse is simply not possible. Vaginal dryness is another reason that pain can result from sexual intercourse, with dryness in older women often attributable to changes in estrogen levels that bring on menopause. It’s also possible that a lack of foreplay is involved during intercourse, so that there is no vaginal lubrication to assist with penetration.

There are certain abnormalities possible in the interior of the uterus, such as fibroid growth, a tilted uterus, or a uterus which is prolapsed into the vagina. If any of these abnormalities is present during sexual intercourse, it is quite likely that the female will experience the significant pain of dyspareunia.

Infections can occur to either the ovaries or to the urinary tract, and these can cause severe discomfort during sex. Sometimes scar tissue is left behind from surgeries of the past, and this scar tissue can cause ongoing pain during intercourse. It’s also possible that there is some kind of endometriosis present, which is scar tissue external to the uterus, but not related to any kind of surgery.

Anyone who has been afflicted by pelvic inflammatory disease will also probably be subject to the discomfort of dyspareunia during sex. All of these causes are physical in nature, and some of them include a medical component because of some condition present in the body.

One distinct cause of dyspareunia which is completely unrelated to physical sources is that of becoming extremely anxious or tense during sex, possibly from an experience or fear of previous painful episodes. It’s also possible that the female partner is unable to become aroused, and in this case, the same kind of situation occurs as might be expected during menopause, i.e. vaginal dryness resulting in extreme difficulty of penetration, and the pain associated with all that.

Treatments for dyspareunia

The way dyspareunia is treated will depend on what the underlying cause is.

For instance, if the cause of dyspareunia is the onset of menopause, there will be inadequate lubrication at the genital site because of the low estrogen levels typical of that time of life. This can be treated with topical estrogen, which can safely be applied directly to the vagina. The U.S. Food and Drug Administration (FDA) has approved several medications for this purpose, including ospemifene, which can be used to treat moderate to severe dyspareunia when vaginal lubrication is indicated.

While ospemifene works in much the same way that estrogen does on the vaginal lining, it has none of the harmful effects that estrogen might on the lining of the uterus or on the breasts. However, a notable drawback of this type of medication is that it is relatively expensive, and it sometimes causes hot flashes in postmenopausal females.

If dyspareunia is caused by an infection or some other medical condition, then treating that underlying medical condition may solve the problem with dyspareunia as well. For instance, if dyspareunia is due to a yeast infection, it’s likely that by clearing up the yeast infection, the pain during sexual intercourse will also be resolved.

Apart from medications and lubricants, there are also therapies which can be successful in treating dyspareunia. For example, desensitization therapy advocates relaxation exercises, which have the effect of decreasing pain around sensitive areas of the body. A therapist might recommend Kegel exercises, which are pelvic floor exercises to decrease the pain associated with sexual intercourse.

If you have experienced a fairly long history of pain and discomfort during intercourse, it is very possible that you will also have developed a negative emotional response to sex, and that you might consider it more an ordeal than a pleasure. Sex therapy can help resolve some of these emotional issues associated with chronic pain during intercourse, and that in turn can lead to a more enjoyable and less uncomfortable experience.

In cases like these, it’s sometimes common for two partners to avoid intimacy because of the pain caused to the female, so there could be an added problem with communication between them before real intimacy can be restored. Sex therapists recognize when situations like these have occurred, and are often able to counsel couples so that communication can be restored and intimacy is again possible.

Prevention of dyspareunia

Prevention of dyspareunia can take several approaches, depending on whether or not a woman has experienced dyspareunia in the recent past, and what the likely cause of that pain and discomfort might have been. When vaginal infections have been an issue in a woman’s recent past, it would be a good idea to wear cotton underclothing, and make sure that the genital area does not stay wet for any prolonged period, for instance when it’s very hot and humid outside, and it causes you to sweat more than normal. Another good example is swimming in the summer time – it might feel good to take several dips in the swimming pool throughout the day, but each time that will leave you wet for a while until drying occurs.

To help discourage bladder infections or urinary tract infections, try to get in the habit of wiping front to back after urination, rather than the other way around. You should also make a point of urinating fairly soon following an episode of sexual intercourse with your partner.

If you are consistently bothered by vaginal dryness, and you are not at menopause age, you should take steps to increase lubrication of the vagina prior to intercourse. Sometimes the problem is simply one of inadequate arousal during foreplay, and this is something you will have to discuss with your partner frankly, so that you can come to a resolution together. If there is another reason for vaginal dryness, it can be resolved by applying a topical lubricant, which makes penetration less painful, and which may enhance the experience for both parties.

It is possible that dyspareunia can result from a sexually transmitted disease (STD), and one of the best ways to avoid this scenario is to have a relationship with a single partner only, rather than multiple partners. You can also avoid STDs by making sure your partner uses condoms all the time, so nothing can be transmitted to you. The most effective way of avoiding any kind of sexually transmitted disease is of course to completely abstain from sex, although this may be the least appealing alternative.

If you have a history of endometriosis, you should avoid allowing deep vaginal penetration, since this is likely to exacerbate the situation. As an alternative, you could try and schedule most of your episodes of sexual intercourse during the first two weeks after menstruation, when endometriosis is generally less painful.