Painful Sex – Dyspareunia

What causes dyspareunia?

Several conditions can cause dyspareunia. For some, it’s a sign of a physical problem. Others may experience pain as a result of emotional factors.

Common physical causes of dyspareunia include:

• 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 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

What are the symptoms of dyspareunia?

Dyspareunia pain can vary making it important to visit your doctor for a proper assessment. 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

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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 percent of women have painful sex 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

How’s dyspareunia diagnosed?

With all of the causes and symptoms of dyspareunia that can also be associated with many other issues related to painful sex, it is important to get diagnosed by a qualified medical doctor. 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
• counselling to determine the presence of emotional causes

How’s 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 oestrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of oestrogen to the vagina.

Home care

These home remedies can also reduce dyspareunia symptoms and have less painful sex:

• Use water-soluble lubricants.
• 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.
• Apply an ice pack to the vulva to calm burning after sex.

Alternative therapies

Your doctor may also recommend therapy. This can include desensitisation therapy or sex therapy. In desensitisation 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.

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) by using condoms or other barriers.
• Encourage natural vaginal lubrication with enough time for foreplay and stimulation.

Final Thoughts

Dyspareunia is a very broad term with many options as to what may be causing it. It is important to be open and honest with your healthcare provider and partner about your issues. Engaging in alternatives to sexual intercourse may be helpful until any 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.