What is dyspareunia?
Dyspareunia , which is pain during sexual intercourse, can occur for reasons ranging from structural problems to psychological concerns. Many women experience pain during intercourse at some point in their lives. The medical term for pain during sexual intercourse is dyspareunia, which is defined as persistent or recurrent genital pain that occurs just before, during, or after intercourse. Dyspareunia can be divided into two categories as deep and superficial. If you are experiencing pain during sexual intercourse, you should talk to your doctor. Treatments focus on the cause of the pain and can help eliminate or reduce this common problem.
What causes dyspareunia?
Physical causes of pain during sexual intercourse vary depending on whether the pain is caused by insertion (superficial) or by deep pushing. Emotional factors can be associated with many types of painful relationships.
Superficial dyspareunia is pain caused by superficial entry and exit during sexual intercourse. Superficial (entry) pain during penetration can be associated with a number of factors, including:
- Insufficient lubrication: This is often the result of insufficient foreplay. A drop in estrogen levels after menopause or childbirth or while breastfeeding can also be a cause. Some medications are known to affect sexual desire or arousal, which can reduce lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines, and some birth control pills.
- Injury, trauma, or irritation: This includes injury or irritation due to an accident, pelvic surgery, female genital mutilation, or an incision made during childbirth (episiotomy) to widen the birth canal.
- Inflammation, infection, or skin disorder: An infection in your genital area or urinary tract can cause pain during intercourse. Eczema or other skin problems in your genital area can also be a cause.
- Vaginismus: These involuntary spasms of the vaginal wall muscles can make penetration painful.
- Congenital abnormality: A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or the development of a membrane that blocks the vaginal opening (imperforated hymen), can cause dyspareunia.
Deep dyspareunia is pain that occurs with deep entry and exit during sexual intercourse. The pain that occurs in this way may be worse in certain positions.
Causes of deep dyspareunia include:
- Certain diseases and conditions: These include endometriosis , pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis , irritable bowel syndrome , pelvic floor dysfunction, adenomyosis , hemorrhoids , and ovarian cysts .
- Surgeries or medical treatments: Scarring from pelvic surgery, including hysterectomy, can cause pain during intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can also cause changes that make sex painful.
Emotions are deeply intertwined with sexual activity, so they may play a role in the problem of pain during intercourse.
Emotional factors include:
- Psychological issues: Anxiety, depression, worries about your physical appearance, fear of intimacy, or relationship problems can all contribute to low arousal and the resulting discomfort or pain.
- Stress: Your pelvic floor muscles tend to contract in response to stress in your life. This can contribute to pain during intercourse.
- History of sexual abuse: Not everyone with dyspareunia has a history of sexual abuse, but if you have been abused this may play a role.
It can be difficult to tell whether emotional factors are associated with dyspareunia. The initial pain can lead to a fear of recurring pain, making it difficult to relax, which can lead to more pain. If you associate sex with pain, you may begin to avoid sexual intercourse.
What are the symptoms of dyspareunia?
If you have dyspareunia, ie pain during sexual intercourse, you may feel:
- Pain only on sexual (penetration) entry
- Pain with any type of penetration, including wearing a tampon
- Deep pain when pushing
- aching or aching pain, such as burning
- Throbbing pain that lasts hours after intercourse
When should you see a doctor?
If you have recurring pain during sexual intercourse, it is useful to see a doctor. Treating the problem can help your sex life, emotional state, and self-confidence.
Which doctor should I go to for dyspareunia?
The first doctor you should see for pain during sexual intercourse is a gynecologist. If the cause of your pain is a different situation, he will refer you to a relevant doctor.
How is dyspareunia diagnosed?
A medical evaluation for pain during intercourse usually consists of:
- A comprehensive medical history: Your doctor may ask you when your pain started, where it is, how it feels, and whether it occurs with every sexual partner and in every sexual position. Your doctor may also ask about your sexual history, history of surgery and birth. Don’t let embarrassment stop you from answering correctly. These questions provide clues as to the cause of your pain.
- Pelvic exam: During a pelvic exam, your doctor may check for signs of skin irritation, infection, or anatomical problems. He or she may also look at your genitals and try to find your pain by applying gentle pressure to your pelvic muscles. A visual examination of your vagina may also be done using an instrument called a speculum to separate the vaginal walls . Some women who experience pain during sexual intercourse also experience discomfort during a pelvic exam. You may want to stop the exam if it is too painful.
- Other tests: If your doctor suspects certain causes of painful intercourse, they may also recommend a pelvic ultrasound.
How is dyspareunia treated?
Treatment options vary depending on the cause of the pain.
If an infection or medical condition is causing pain during intercourse, treating the cause may resolve your issue. Changing medications that are known to cause vaginal dryness issues may also make your symptoms go away. For many postmenopausal women, pain during intercourse is vaginal dryness caused by low estrogen levels. Usually this can be treated with topical estrogen applied directly into the vagina.
The Food and Drug Administration (FDA) has approved the drug ospemifene for the treatment of moderate to severe dyspareunia in women with problems with vaginal dryness. Ospemifene acts like estrogen in the vaginal lining. The disadvantages are that the drug can cause hot flashes and carries the risk of stroke, blood clots and cancer of the lining of the uterus.
Another drug to relieve painful intercourse is prasterone. It is a capsule that you insert into your vagina every day.
Remember, your doctor will decide which medicine to take and how.
Non-drug treatments can also help dyspareunia, such as:
- Desensitization therapy: You learn about vaginal relaxation exercises that can reduce pain.
- Counseling and therapy: If sexual intercourse has been painful for a while, you may have a negative emotional response to sexual arousal, even after treatment. If you and your partner have avoided intimacy due to pain during intercourse, you may need help improving communication and re-establishing sexual intimacy with your partner. Talking to a counselor or therapist can help resolve these issues. Cognitive behavioral therapy can be helpful in changing negative thought patterns and behaviors.
What is good for pain during sexual intercourse?
You and your partner can minimize pain by making a few changes to your sexual routine, such as:
- Changing positions: If you have a sharp pain when pushing, you can try different positions, such as being on top. In this position, you can regulate the penetration to a depth that suits you.
- Communicate: You can talk to your partner about what feels good and what doesn’t. If you need your partner to go slow, you should tell them.
- Take your time: Longer foreplay can help revive your natural lubrication. You can reduce pain by delaying penetration until you are fully stimulated.
- Using lubricants: A personal lubricant can make intercourse more comfortable. You can try different brands until you find the brand you like.