Causes, symptoms, treatment and how to prevent Dyspareunia

Definition 

Dyspareunia is the Persistent or recurrent genital pain that occurs just before, during or after intercourse.

Dyspareunia can also be said as pain when any other sexual activity that involves when penetration is attempted.

Facts about Dyspareunia 

  • Dyspareunia affects both men and women 
  • Dyspareunia is more common in women than men. It has many possible causes, but it can be treated.
  • Pain can range from moderate to severe.
  • Reasons can be physical or psychological, and they may be related to menopause.
  • Solutions include estrogen therapy, changing existing medications, and counseling.

Causes 

Causes of dyspareunia are varied and include physical factors, psychological factors, or both.

The location of the pain may help identify a specific physical cause.

Physical causes: 

  • Entry pain: this pain may be associated with the following;
  1. vaginal dryness
  2. vaginismus
  3. genital injury and others.
  • Vaginal dryness: During sexual arousal, glands at the entrance of the vagina secrete fluids to aid intercourse.

 Too little fluid can lead to painful intercourse.

Inadequate lubrication can arise from:

  1. a lack of foreplay
  2. a reduction in estrogen, particularly after menopause or childbirth
  3. medications, including some antidepressants, antihistamines, and birth control pills
  • Vaginismus: The involuntary contraction of the pelvic floor muscles causes vaginismus, leading to painful sexual intercourse.
  1. Women with vaginismus may also experience difficulty with gynecological examinations and tampon insertion.
  2. There are several forms of vaginismus. 
  3. Symptoms vary between individuals and range from mild to severe. 
  4. It can be caused by medical factors, emotional factors, or both.
  • Genital injury: Any trauma to the genital region can lead to dyspareunia. 

Examples include; 

  1. female genital mutilation (FGM)
  2. pelvic surgery
  3.  injury arising from an accident.

Note that , Painful intercourse is also common after childbirth. Some research suggests 45 percent of participants experienced postpartum dyspareunia.

  • Inflammation or infection: Inflammation around the vaginal opening is called vulvar vestibulitis. This can cause dyspareunia. 
  1. Vaginal yeast infections
  2. urinary tract infections
  3. sexually transmitted infections (STIs) can also lead to painful intercourse.
  • Skin disorders or irritation: Dyspareunia may arise from the following ;
  1. Eczema
  2. lichen planus
  3. lichen sclerosus
  4. and other skin problems in the genital area.
  • Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.
  • Abnormalities at birth: Less common underlying causes of dyspareunia include;
  1.  vaginal agenesis; , when the vagina does not develop fully
  2.  imperforate hymen, in which the hymen blocks the vaginal opening.

 Physical causes ; Deep pain 

If pain occurs during deep penetration or is more acute in particular positions, it may be the result of a medical treatment or a medical condition.

Medical treatments that can lead to pain include; 

  1. pelvic surgery
  2. hysterectomy
  3. some cancer treatments as well 

Some otherMedical conditions include:

cystitis: An inflammation of the bladder wall, usually caused by bacterial infection

endometriosis: A condition arising from the presence of tissue from the uterus in other areas of the body

fibroids: Non-cancerous tumors that grow on the wall of the uterus

interstitial cystitis: A chronic painful bladder condition

irritable bowel syndrome (IBS): A functional disorder of the digestive tract

ovarian cysts: A build-up of fluid within an ovary

pelvic inflammatory disease (PID): Inflammation of the female reproductive organs, usually caused by infection

uterine prolapse: One or more pelvic organs extend into the vagina

Psychological causes

Psychological causes; psychological factors can play a role in painful intercourse. Some of which are;

  1. Anxiety
  2.  Fear
  3. depression can inhibit sexual arousal and contribute to vaginal dryness or vaginismus
  4. Stress can trigger a tightening of the pelvic floor muscles, resulting in pain
  5. A history of sexual abuse or sexual violence may contribute to dyspareunia.

Risk factors 

  1. Both women and men can experience dyspareunia.
  2. Dyspareunia is one of the most common problems of postmenopausal women.

Sexual dysfunction (eg pain during sex amongst others) affects more than 70% of Ghanaian women who are sexually active.

You’re at an increased risk if you:

  1. take medications that cause vaginal dryness
  2. have a viral or bacterial infection

Symptoms of Dyspareunia 

Dyspareunia pain can vary. Pain may occur:

  1. in the vagina, urethra, or bladder
  2. during penetration
  3. during or after intercourse
  4. deep in the pelvis during intercourse
  5. after pain-free intercourse
  6. only with specific partners or circumstances
  7. with tampon use
  8. along with burning, itching, or aching
  9. with a feeling of stabbing pain, similar to menstrual cramps

Diagnosis

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 test. 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

counseling to determine the presence of emotional causes

Treatment

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:

  1. antibiotics
  2. antifungal medicines
  3. topical or injectable corticosteroids

Prevention 

There’s no specific prevention for dyspareunia. 

But you can do the following to reduce the risk of pain during intercourse:

  1. After childbirth, wait at least six weeks before resuming sexual intercourse.
  2. Use a water-soluble lubricant when vaginal dryness is an issue.
  3. proper hygiene.
  4. Get proper routine medical care.
  5. Prevent sexually transmitted diseases (STDs) by using condoms or other barriers.
  6. Encourage natural vaginal lubrication with enough time for foreplay and stimulation.

Home Remedies for Dyspareunia 

These home remedies can also reduce dyspareunia symptoms:

  1. Use water-soluble lubricants.
  2. Have sex when you and your partner are relaxed.
  3. Communicate openly with your partner about your pain.
  4. Empty your bladder before sex.
  5. Take a warm bath before sex.
  6. Take an over-the-counter pain reliever before sex.
  7. Apply an ice pack to the vulva to calm burning after sex.

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.

Take home 

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 can act 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.

Alternatives to sexual intercourse may be useful until underlying conditions are treated. 

You and your partner can also use other techniques for intimacy until penetration is more comfortable. Some of the alternatives are ;

  1. Sensual massage
  2. Kissing
  3. Cuddling 

                                                 THANK YOU

WRITTEN BY JOSEY, CEO OF JOSEYS HEALTH CORNER

References

https://www.medicalnewstoday.com/articles/192590

https://www.healthline.com/health/dyspareunia

https://www.mayoclinic.org/diseases-conditions/painful-intercourse /symptoms-causes/syc-20375967