Dyspareunia is the term for recurring pain in the genital area or within the pelvis during sexual intercourse. The pain can be sharp or intense. It can occur before, during, or after sexual intercourse.
Dyspareunia is more common in women than men. It has many possible causes, but it can be treated.
What causes dyspareunia?
Several conditions can cause dyspareunia. For some women, it’s a sign of a physical problem. Other women may experience pain as a result of emotional factors.
Common physical causes of dyspareunia include:
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Vaginal dryness from menopause, childbirth, breastfeeding, medications, or too little arousal before intercourse
Skin disorders that cause ulcers, cracks, itching, or burning
Infections, such as yeast or urinary tract infections (UTIs)
Injury or trauma from childbirth, an accident, an episiotomy, a hysterectomy, or pelvic surgery
Vulvodynia, or pain centred in the vulva area
Vaginitis, or inflammation of the vagina
Vaginismus, or a spontaneous tightening of the muscles of the vaginal wall
Endometriosis
Cystitis
Pelvic inflammatory disease (PID)
Uterine fibroids
Irritable bowel syndrome (IBS)
Radiation and chemotherapy
Factors that reduce sexual desire or affect a person’s ability to become aroused can also cause dyspareunia. These factors include:
Stress, which can result in tightened muscles of the pelvic floor
Fear, guilt, or shame related to sex
Self-image or body issues
Medications such as birth control pills
Relationship problems
Conditions such as cancer, arthritis, diabetes, and thyroid disease
History of sexual abuse or rape
Who’s at risk for dyspareunia?
Both women and men can experience dyspareunia, but the condition is more common in women. Dyspareunia is one of the most common problems of postmenopausal women. Around 75 per cent of women have painful intercourse at some time, according to the American College of Obstetricians and Gynecologists (ACOG). You’re at an increased risk if you:
Take medications that cause vaginal dryness
Have a viral or bacterial infection
Are postmenopausal
What are the symptoms of dyspareunia?
Dyspareunia pain can vary. Pain may occur:
In the vagina, urethra, or bladder
During penetration
During or after intercourse
Deep in the pelvis during intercourse
After pain-free intercourse
Only with specific partners or circumstances
With tampon use
Along with burning, itching, or aching
With a feeling of stabbing pain, similar to menstrual cramps
How is dyspareunia diagnosed?
Several tests help doctors identify and diagnose dyspareunia. Your doctor will start by creating a complete medical and sexual history. Possible questions your doctor may ask you include:
When and where do you feel pain?
Which partners or positions cause pain?
Do any other activities cause pain?
Does your partner want to help?
Are there other conditions that may be contributing to your pain?
A pelvic examination is also common in diagnosis. During this procedure, your doctor will look at the external and internal pelvic area for signs of:
Dryness
Inflammation or infection
Anatomical problems
Genital warts
Scarring
Abnormal masses
Endometriosis
Tenderness
The internal examination will require a speculum, a device used to view the vagina during a Pap smear. Your doctor also may use a cotton swab to apply slight pressure to different areas of the vagina. This will help determine the location of the pain.
The initial examinations may lead your doctor to request other tests, such as:
Pelvic ultrasound
Culture test to check for bacteria or yeast infection
Urine test
Allergy test
Counselling to determine the presence of emotional causes
How is dyspareunia treated?
Medications
Dyspareunia treatments are based on the cause of the condition. If your pain is caused by an underlying infection or condition, your doctor may treat it with:
Antibiotics
Antifungal medicines
Topical or injectable corticosteroids
If a long-term medication is causing vaginal dryness, your physician may change your prescription. Trying alternative medications may restore natural lubrication and reduce pain.
Low estrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of estrogen to the vagina.
An estrogen-free drug called ospemifene (Osphena) acts like estrogen on vaginal tissues. It’s effective in making the tissues thicker and less fragile. This can reduce the amount of pain women experience with sexual intercourse.
Home care
These home remedies can also reduce dyspareunia symptoms:
Use water-soluble lubricants. Purchase water-soluble lubricants here.
Have sex when you and your partner are relaxed.
Communicate openly with your partner about your pain.
Empty your bladder before sex.
Take a warm bath before sex.
Take an over-the-counter pain reliever before sex. Find a selection of pain relievers online.
Apply an ice pack to the vulva to calm burning after sex. Shop for ice packs.
Alternative therapies
Your doctor may also recommend therapy. This can include desensitization therapy or sex therapy. In desensitization therapy, you’ll learn vaginal relaxation techniques, such as Kegel exercises, that can decrease pain. In sex therapy, you can learn how to reestablish intimacy and improve communication with your partner.
What is the outlook for dyspareunia?
Alternatives to sexual intercourse may be useful until underlying conditions are treated. You and your partner can use other techniques for intimacy until penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual masturbation may be satisfying alternatives.
Preventing dyspareunia
There’s no specific prevention for dyspareunia. But you can do the following to reduce the risk of pain during intercourse:
After childbirth, wait at least six weeks before resuming sexual intercourse.
Use a water-soluble lubricant when vaginal dryness is an issue.
Use proper hygiene.
Get proper routine medical care.
Prevent sexually transmitted diseases (STDs) with safe sex.
Encourage natural vaginal lubrication with enough time for foreplay and stimulation.
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