All About Dyspareunia

All About Dyspareunia
What Is Dyspareunia?
Dyspareunia is the term for recurrent painful sexual intercourse.  Although this condition affects both sexes, dyspareunia is more prevalent in women and is described as genital pain during initial penetration, thrusting and following intercourse. Some women may also experience severe tightening of the vaginal muscles during penetration – a condition known as vaginismus.   Women with dyspareunia may complain of a well-defined and localized pain, and express a general disinterest in and dissatisfaction with intercourse, a response that stems from associated discomfort. 

What Causes Dyspareunia?
Common causes include
  • Vaginal dryness due to inadequate lubrication
  • Atrophic vaginitis, which is a thinning of the vaginal lining in postmenopausal women
  • Side effects from drugs such as antihistamines
  • An allergic reaction to clothing, spermicides or douches
  • Excessive or poor hygiene
  • Endometriosis (please see All About Endometriosis)
  • Vulvar vestibulitis or inflammation of the area surrounding the vaginal opening
  • Friction irritation
  • Vaginismus or intensive involuntary contraction of muscles surrounding the outer 1/3rd of the vagina
  • Vaginal abrasions or scarring
  • Intercourse too soon after abdominal or pelvic surgery or childbirth
  • Lactation
  • Cancer and radiation treatment
  • Nerve damage
  • Hormonal problems
  • Size incompatibility
  • Skin diseases affecting the vaginal area
  • Urinary tract infections, cysts, vaginal yeast infections or sexually transmitted diseases (STDs)
  • Psychological trauma
Atrophic vaginitis from inadequate estrogen levels, inadequate lubrication, vaginismus and fungal or bacterial vaginitis are associated with painful entry; while deep pain occurs with other conditions previously noted, including endometriosis, vaginal abrasions and scarring. 
Diagnosing Dyspareunia
A diagnosis is typically made based on a woman’s symptoms, medical and sexual history and a physical exam.  Being able to differentiate between touching the genitals and early penetration pain versus deeper penetration pain will give a clue as to what is causing the dyspareunia.  Generally, a physician will ask where and when the pain is occurring.  During the exam, the vaginal wall will be checked for dryness, infection (including yeast), scarring, swelling and STDs (including herpes). The physician will also perform an internal pelvic examination to look for pelvic masses, tenderness or signs of endometriosis.   Some disorders have similar or even the same symptoms, therefore the clinician has to differentiate and rule out causes to establish a precise diagnosis.  A physician may also suggest speaking with a counselor to determine a history of sexual abuse or trauma, which may contribute to the symptoms. 
Treatment Options
If dyspareunia is just a case of dryness, the symptoms can be cleared up quickly with water-based cream or jelly lubricants.  Other dyspareunia conditions tend to be more complicated and require various treatment options.  Women experiencing dryness from atrophic vaginitis may be prescribed hormonal creams to target damaged nerves and tissues, revive sensitivity and increase lubrication.  Urinary tract or vaginal yeast infections can be treated with antibiotic or antifungal therapy.  STDs require longer and more intensive treatments with antibiotics.
Depending on a woman’s medical history, exam and diagnostic test results, treatment options for dyspareunia may include relaxation exercises to help a woman regain control over vaginal muscles, reduce pain and make sexual intercourse more pleasurable.  Modification of sexual technique may help reduce pain with intercourse.  Increasing foreplay and delaying penetration, until maximal arousal, may stimulate vaginal lubrication and decrease pain with penile entry.   
Prevention Options
·        Shower daily
·        Avoid tightly fitted clothing
·        Wear cotton underwear
·        Change into dry clothing promptly after swimming
·        Avoid bladder infections, wipe from front to back following toilet use
·        Practice abstinence or safe sex to avoid STD’s
·        Use a lubricant to prevent dryness or seek professional treatment
·        Avoid deep penetration or have sex during the week or two following menstruation (before ovulation), especially if diagnosed with endometriosis when the condition tends to be less painful. 
·        Wait at least 6-weeks after childbirth before resuming sexual relations
Regardless of the cause, dyspareunia can be extremely stressful for a woman, especially if it interferes with intimacy and personal relationships.  Many causes of dyspareunia are rooted in a physical condition that can be cured or controlled with proper medical care.   Thorough assessment is imperative in order to identify the particular type of dyspareunia a woman has, and to offer correct treatment, including counseling or therapy.
All treatment options for dyspareunia must be discussed with a physician.  However, it is important for a woman to understand that this problem does not have to control one’s quality of life forever. 

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