Dyspareunia

Dyspareunia – What is it & How to get rid of it?

Dyspareunia is a medical condition in which the patient experiences pain during or after sexual intercourse. [1]

This pain can be experienced in the clitoris, labia, or vagina, and ranges from moderate to severe. While dyspareunia is a condition that affects both men and women, it generally affects more women than men. [2]

You Are Not Alone

A study conducted by the American Academy of Family Physicians revealed that almost 20 % of all women experience dyspareunia.[3] The symptoms associated with this medical condition can last for months and years.

Tackling dyspareunia is especially difficult for people affected by psychological issues. In such cases, counseling becomes mandatory. Painful sex is a trenchant issue, one that is capable of ruining relationships and a person’s emotional well-being. It is, thus, that the problem of dyspareunia should not be avoided or taken lightly.

Painful sex is a trenchant issue, one that is capable of ruining relationships.

What Causes Dyspareunia?

The most common causes of dyspareunia include:

Vaginal Dryness

When a woman is sexually aroused, the vaginal glands secrete fluids to reduce pain during intercourse. Inadequate fluid secretion by the vaginal glands leading to vaginal dryness is one of the most common causes of dyspareunia. [4]

Vaginal dryness can be caused by numerous factors, including lowered estrogen production and medication. Vulvovaginal atrophy is another common cause of dyspareunia. Though this condition also affects younger women, it is widely prevalent in women aged above 50.

This medical condition leads to reduced vaginal lubrication and, thus, dyspareunia.

Vaginal Skin Problems

The skin present on the external parts of the female genitalia is fragile and can be easily affected by inflammation and skin-related issues. For instance, eczema can cause vaginal skin to become itchy and scaly.

Lichen planus leads to ulceration, and lichen sclerosis is a medical condition that promotes vaginal inflammation. Dermatitis caused by the perfumes and preservatives present in bathing and cosmetic products can lead to erythema and fissuring.

Leukoplakia and vaginal discharge are other common vaginal skin-related problems.

Vaginal Inflammation and Genital Injury

Vulvar vestibulitis is one of the many medical conditions that can cause inflammation around the vaginal opening.

Similarly, sexually transmitted infections and urinary tract infections can also lead to vaginal soreness and, thus, dyspareunia. Another common cause of dyspareunia in women is a genital injury. Researches have shown that almost 45% of all women experience painful intercourse after childbirth. [5]

Similarly, female genital mutilation, as well as other forms of genital injury, are also a common cause of dyspareunia.

Emotional Issues

Emotional issues are also a contributive factor to dyspareunia. Stress and anxiety about sex reduce libido [6] and can make sex an extraordinarily tricky process.

Similarly, women who have faced sexual or emotional abuse in the past also often find it difficult to enjoy sexual intercourse.

Emotional issues as stress and anxiety are also a contributive factor to dyspareunia.

Symptoms and Diagnosis

Moderate to severe pain at the vaginal opening or deep in the pelvis during intercourse is the defining symptom of dyspareunia.

Similarly, reduced interest or reduced pleasure during sex is another symptom often linked with dyspareunia. Experiencing pain while touching genitals can also be a symptom of dyspareunia. Depending on the causative factors, the symptoms associated with dyspareunia can last from months to years.

Dyspareunia caused by vaginal dryness can be easily treated within a few weeks. If the cause of painful intercourse is a sexually transmitted infection or vaginal infection, the problem typically goes away within a week with the right treatment. However, it can take a while to treat dyspareunia triggered by emotional issues.

If you have been experiencing painful sex, it is best to see a doctor immediately. Your doctor will ask you questions about your sexual and surgical history and make decisions based on that. Further to that, a pelvic examination is mostly conducted to check for signs and symptoms related to the condition.

During the examination, your doctor will move around your genitals and pelvic muscles to study and understand when and where the pain occurs. Your doctor may also perform a visual examination of the patient’s vagina using a speculum. In some cases, the doctor may also have to conduct a pelvic ultrasound to understand the problem correctly.

Experiencing some discomfort or pain during this examination is common. However, patients must remember to be completely transparent with their doctor and inform them about whatever discomfort and pain they experience.

You should see a doctor if you have dyspareunia.

Treatment Options for Dyspareunia

Dyspareunia is treatable. The duration of the treatment varies depending on the causative factors. Here are a few treatment options for dyspareunia.

  • Women suffering from dyspareunia should work with their partners to enhance their sexual experience. Foreplay should be encouraged to discourage vaginal dryness. The use of erotic fiction and toys can prove to be especially helpful. Women with stiff pelvic muscles must use vaginal dilators.
  • Many women also benefit from a change in their sexual techniques. If you are suffering from dyspareunia, try different positions, and see which sexual positions work best for you. Use a lubricant to reduce pain.
  • Another treatment option for dyspareunia is pelvic floor physiotherapy. This therapy includes finding the precise points that pain during intercourse and using soft-tissue massage techniques to comfort these points. Pelvic floor physiotherapy also teaches the use of unique relaxation techniques and exercises that decrease muscle pain and promote overall sexual well-being.
  • If natural remedies have failed to work for you, medication is your last resort. Dyspareunia caused by various medical conditions and natural processes, such as low estrogen production, menopause, childbirth, etc., can be treated with the help of medication within a few weeks. However, do remember that certain dyspareunia-related medicines leave mild side-effects, such as hot flashes, etc.
  • If the causative factor for dyspareunia includes psychological factors, undergoing sexual counseling is important. Couple therapy will allow your partner to understand the problems you are facing and, thus, help you deal with it.
If you suffer from dyspareunia you should try various sex positions.

Dyspareunia today

Today, a large number of people experience painful sexual intercourse. This condition is called dyspareunia and it can affect both men and women, but women are certainly more affected.

Dyspareunia is often caused by various physical or psychological factors. If there is no proper treatment, it can result in high levels of stress and relationship problems.

The pain is usually from medium to severe. In most cases, the main reason for the occurrence of dyspareunia is the low levels of estrogen. Treatments include estrogen therapy, different medications, and counseling. The pain is concentrated at the vaginal opening or deeper in the pelvis.

Except for the pain, women can also feel itching or burning. If you have any of these symptoms, don’t be ashamed, just remember it’s important to visit your doctor as soon as possible.

Dyspareunia after childbirth

Dyspareunia is a common condition after childbirth. There are reports that 50-60 % of the women experience pain 6-7 weeks after they have given birth. Some of them still feel pain during sexual intercourse up to 6 months later.

Specialists say that breastfeeding keeps the estrogen levels low, which can be the main reason for pain during sex after childbirth. [7]

Another cause of dyspareunia can be the dysfunction of the pelvic floor. The pregnancy leads to extra pelvic pressure and your muscles become weaker. Of course, there are always psychological factors that definitely contribute to the pain.

You may think it’s kind of embarrassing, but it’s not. In fact, it happens to many people and they search for the best specialists to help them relieve the pain. Before you visit a doctor, there are certain things you might consider doing at home.

Women suffer from dyspareunia after childbirth.

Dyspareunia and menopause

Try to spend more time on foreplay, including oral sex or mutual masturbation, depending on your preferences. More and more couples use water-based lubricants and say they can be really helpful for relieving the pain and increasing pleasure from sexual intercourse.

Menopause is a difficult period for lots of women. It’s a big change for the female body and causes various unpleasant symptoms. One of the most frequent symptoms, that women in menopause report, is the pain during intercourse.

Again, this pain is related to the low levels of estrogen and progesterone, which women have when they enter menopause.

The low levels of these hormones lead to vaginal atrophy and low libido. The vaginal walls become thin, dried and inflammatory during menopause. In some cases, vaginal atrophy can lead to urinary problems. [8]

If the symptoms seriously affect your relationship or quality of life as a whole, you don’t have to hesitate to visit the doctor.

Doctors can recommend you to use different lubricants – flavored or with herb extracts.

If it does not help, they might prescribe you an estrogen therapy, which can be in diverse forms. There are special vaginal creams that have to be applied directly to the vagina a couple of times a week. Another option is the vaginal rings.

You have to insert them in the vagina to release a dose of estrogen, but they need to be replaced in three months. Oral estrogen tablets are another variant that is placed in the vagina once a week. And finally, you might be prescribed the well-known oral estrogen pills.

They can even treat the other symptoms of menopause, but doctors don’t prescribe them to women, who have already had cancer. Remember, if you want to sustain the benefits of estrogen therapy, you should not stop having regular sex.

Dyspareunia during ovulation

Unfortunately, some women can’t even think of sexual intercourse during their ovulation. The ovulation can cause mild pain or severe discomfort that can last from a couple of minutes to hours. The egg, which develops in the ovary is surrounded by follicular fluid.

When women are ovulating, the egg and this fluid are released from the ovary and they might irritate the abdominal cavity lining. That is why women experience dyspareunia during their ovulation. Luckily, it is for short periods, so you can just wait for the pain to diminish, then enjoy the pleasure from the sexual activity as usual. [9]

Dyspareunia during women’s ovulation is considered normal most of the time and does not require special treatment. If the pain is not that intense, you can ask your partner to give you a nice relaxing massage or take a warm bath in order to relieve the pain more quickly.

Bleeding after sex is not common.

Bleeding and dyspareunia

Except for the pain during sexual intercourse, some women can experience bleeding from the vagina after the act. Sometimes, the bleeding does not include pain and it can be from the uterus, the cervix or the other organs, that are located near the vagina. This may sound fearful, but postcoital bleeding can be one of the first signs of cervical cancer. [10]

So, if you notice bleeding, it will be better to get tested. There are different reasons why a woman might bleed after sex. We all know that most virgin women bleed after their first sexual intercourse, because of the stretching hymen.

There are other activities that might cause dyspareunia and bleed such as physical exercises and the usage of tampons. It’s frequently reported that postcoital bleeding tends to stop without any special treatment. It is also believed that postcoital bleeding might happen through the pregnancy, because of the cervical polyps.

The tissue of these polyps can be damaged easily and that is why the bleeding occurs. Postcoital bleeding can happen due to trauma, especially when the intercourse is non-consensual. [11] If the bleeding is not strong, specialists will assure you that treatment is not necessary.

No matter what causes the dyspareunia, it might make women feel awful discomfort and severe pain. When it seriously interferes with their normal lives and sexual wellness, they should not be embarrassed to share their problems and look for the best treatment.

Sometimes dyspareunia can be more of a psychological problem and be healed by counseling, but in other cases, it might require taking estrogen pills. 

Dyspareunia – Conclusion

Dyspareunia is not an uncommon problem, especially in women.

This medical condition can affect the sexual and mental well-being of the people suffering from it and, thus, should not be ignored. The good thing is that the pain experienced by dyspareunia patients can be alleviated by making a specific lifestyle and sexual changes. People suffering from acute dyspareunia should consult a doctor and rely on medication to ease the symptoms.

If emotional factors are spurring dyspareunia, it is essential to undergo therapy.

Sources:

[1] What causes dyspareunia, or painful intercourse? [online]. https://www.medicalnewstoday.com/articles/192590.php

[2] What You Need to Know About Dyspareunia (Painful Intercourse) [online]. https://www.healthline.com/health/dyspareunia

[3] DEAN A. SEEHUSEN, DREW C. BAIRD, DAVID V. BODE; Dyspareunia in Women. October 1, 2014. (Am Fam Physician. 2014;90(7):465-470. pages 465-470

[4] HISASUE S., KUMAMOTO Y., SATO Y.; Prevalence of female sexual dysfunction symptoms and its relationship to quality of life: a Japanese female cohort study. Urology. 2005 Jan;65(1):143–148. 

[5] BARRETT G., PENDRY E., PEACOCK J., CIVTOR C., THAKAR R., MANYODA I.; Women’s sexual health after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology. pages 186-195

[6] SCOTT, Elizabeth; How Stress Can Cause a Low Libido [online]. https://www.verywellmind.com/how-stress-can-lead-to-low-libido-3145029

[7] BARRETT G., PENDRY E., PEACOCK J., CIVTOR C., THAKAR R., MANYODA I.; Women’s sexual health after childbirth: A pilot study. Archives of Sexual Behavior. (1999) pages 56, 119-123

[8] CHANNON, L.D., BALLINGER, S.E.; Some aspects of sexuality and vaginal symptoms during menopause and their relation to anxiety and depression. Br J Med Psychol. 1986 Jun;59( Pt 2):173–180.

[9] BARON, S.R., FLORENDO, J., SANDBO, S.; Sexual Pain Disorders in Women. In: Clinical Reviews. 2011 May 21(5):32-38.

[10] DE SOUZA N.M., SOUTTER W.P., MCINDOE, G.A., GILDERDALE, D.J., KRAUSZ, T.; Stage I cervical cancer: tumor volume by magnetic resonance imaging of screen-detected versus symptomatic lesions. Journal of the National Cancer Institute. 1997;89(17):1314–1315.

[11] MCLEER, S.V., ANWAR, R.; A study of battered women presenting in an emergency department. The American Journal of Public Health. 1989;79(1):65–66.