Dyspareunia – Definition, Causes, Symptoms and Treatment

Dyspareunia Definition

Dyspareunia is the painful sexual intercourse due to medical or psychological causes.

The word dyspareunia is pronunciated as dis′pa-rū′nē-ă.

Male Dyspareunia

Dyspareunia in men is not commonly seen, if occurs it is due to underlying medical causes.

Causes of Dyspareunia in Men

Dyspareunia in men can result from allergic rashes over the penis, physical abnormities like tight foreskin or a bowed erection and infection of testes or prostate gland.

Interstitial cystitis and gonorrheal infections in men causes intense pain during ejaculation.

Urethritis makes erection of penis painful. Post ejaculation dyspareunia is a rare case of male dyspareunia in which there is persistent pain in the genitals during or after ejaculation.

Female Dyspareunia

Female dyspareunia is a common condition that can be due to various causes. Pain may be superficial or deep; in the external genitalia or in the pelvic area. The pain is often described as burning or cramping pain as in menstrual cycle. In most of the women, development of dyspareunia results in fear or loss of interest in sexual activities.

Causes of Dyspareunia in Women

Dyspareunia causes vary depending on the type of pain whether it is superficial or deep.

Superficial Dyspareunia or Introital Dyspareunia Causes

• Lack of vaginal fluid: If woman is not sexually aroused, there may not be adequate vaginal fluid for lubrication. The reason for lack of vaginal fluid may be insufficient foreplay. This results in painful intercourse.

Other causes of decrease in vaginal fluid are :

Atropic Vaginitis– As age advances, the vaginal lining becomes thin and dry because of decreasing level of estrogen hormone. Dyspareunia menopause is also associated with low hormonal level and vaginal dryness.

Breast feeding– Breast feeding can be another reason for low estrogen level and subsequent dryness of vagina.
Long term administration of antihistamines causes temporary dryness of vagina and painful sex.

• Increased sensitivity near the vaginal area causes entry dyspareunia while inserting the penis inside.
• Infection or Inflammation of urinary tract, external genitalia or Bertholins glands.
• Allergy to condoms and artificial lubricators.
• Injuries near external genitalia.
• Abnormal structure of vagina which may be congenital.
• Surgery in the vagina (stitches to repair episiotomy or to correct pelvic disorders).
• Thick hymen- Hymen is a thin membrane that encircles the vaginal opening. Hymen tears during the first intercourse if it was not previously stretched (use of tampons, sexual play using fingers) causing mild pain and bleeding. Congenitally tight hymen causes pain during sex.
• Vaginismus or insertional dyspareunia- It is the painful muscle spasm around vagina. It is often difficult to differentiate between dispareunia and vaginismus. Any type of dyspareunia may trigger onset of vaginismus.
• Post partum dyspareunia- It is mainly due to the perineal tear during child birth.

Deep Dyspareunia Causes

Deep pain at the time or after sexual intercourse can be due to;

• Dyspareunia Endometriosis– Endometriosis is a gynecological condition in which tissues similar to uterine lining (endometrial- like cells) is found in the pelvic wall, ovaries or the fallopian tubes. Endometriosis makes sexual intercourse painful. Endometriosis also grows over the uterus lining and the condition is known as Adenomyosis.
• Abnormal Pelvic Growth– Tumors or cysts in the ovaries cause discomfort during sexual act. The cysts may rupture or bleed causing pelvic pain.
• Infection of Reproductive Organs– Pelvic and other reproductive organs infection is mainly due to Chlamydia or Gonorrhea organisms. Infection of lining of uterus is called endometritis. Salpingitis is the infection of fallopian tubes. Infection in any of the reproductive structure cause severe pain and fever.
• Adhesions– The band of scar tissue that joins two parts of tissues together are called adhesions. Some times adhesions seen between the organs within the pelvis causes pain during sex. Adhesions may be formed after surgery, infections or after radiotherapy for cancer.
• Retroverted Uterus– Retroverted uterus is a condition in which the uterus is tilted backwards. This condition can make sex painful.
• Fibroids– Fibroids are non cancerous tumors found inside the uterus. Large fibroids can be a cause of painful sex.
• Misplaced Ovaries– Sometimes, during a hysterectomy surgery, ovaries are conserved. As there is no proper support to hold the ovaries in place, it moves down in the pelvis.
• Tumors or cancerous growth in the genital tract.
• Prolapsed uterus.
• Deep Thrust Dyspareunia– Deep thrust dyspareunia is the common type of pain during intercourse dyspareunia caused due to the deep penetration of penis. This condition is common in passionate sexual relation and to an extent depends on the position adapted during sex.

Symptoms of Dyspareunia

Researches show that one in every five women experience dyspareunia. The location of the pain varies greatly in each individual. The common dyspareunia include;

• Pain while inserting a tampon or during penis penetration
• Pain with particular partners.
• Deep pain during thrusting

When to Consult a Professional

Sexual intercourse for the first time may be uncomfortable. However, intense pain during or after sex, must taken into a doctor’s consideration. Care must be taken at an early stage, if not; you may start avoiding sex due to fear of pain.

Diagnosis of Dyspareunia

Dyspareunia is diagnosed mainly based on the symptoms. A complete medical and sexual history and physical examination will help the doctor to come into a conclusion on the cause of dyspareunia.

The doctor may enquire about;

• The exact location, time and duration of pain.
• If the dyspareunia was there from the first intercourse or there were times of painless sex.
• A few questions about your sexual history to eliminate the risk of sexually transmitted diseases.
• If you are over 40 years, you will be asked whether you have reached menopause, if not, if the periods are regular or irregular.
• New moms will be asked about breast feeding as there will be hormonal changes and subsequent dryness of vagina.

Physical examination includes checking the vaginal wall for signs of dryness, infection, inflammation, warts, scars etc. Internal pelvic examination will be done to look for endometriosis and abnormal masses.

Treatment of Dyspareunia

The husband and wife are encouraged to involve in mutual pleasure without penetration. Mutual pleasure can be stimulation that involves mouth, hand or a vibrator that leads to orgasm or ejaculation. Exercises help in relaxation of pelvic muscles. Changing the sexual posture may help in reducing deep pain. Superficial pain can be treated with anesthetic gels or ointments applied before intercourse. Oil based lubricant tends to dry the vagina and damage the latex condoms. Increasing the duration of foreplay is a natural way of increasing vaginal lubrication.

Specific dyspareunia treatments include;

• Antifungal creams for yeast infections.
• Estrogen cream or pills inserted into vagina is helpful in reducing the dryness of vagina after menopause.
• Antibiotics in case of infections.
• Surgical removal or cysts, abscess or large fibroids.
• Surgical correction of a congenitally rigid hymen.
• Uterine prolapse is corrected either by surgery or insertion of pessary that resembles diaphragm.
• Analgesic and antispasmodic drugs for dyspareunia vaginismus.
• Combined medical and surgical treatment is necessary in women with endometriosis dyspareunia.

Dyspareunia Prevention

Sexual intercourse must be avoided for 6 weeks after childbirth. Safe sex must be practiced to avoid sexually transmitted diseases. Sufficient foreplay before sex ensures good lubrication of the vagina. Use cotton under pants, avoid tight garments, and practice good personal hygiene to avoid genital infections.

References :

http://www.hawaii.edu/hivandaids/Dyspareunia%20%20%20Eliciting%20the%20Source%20of%20the%20Pain.pdf

http://www.bmj.com/content/328/7452/1357.full.pdf

http://www.laboratoriosilesia.com/upfiles/sibi/GI081073.