Dyspareunia refers to persistent and recurring pain during intercourse. While this is common in women who have reached menopause, there are several other medical conditions that can lead to Dyspareunia in younger women. When a woman is not able to enjoy her intimate moments, she consciously or unconsciously starts disliking the act and may refuse to participate. This can lead to relationship problems in couple.
What are the symptoms of Dyspareunia?
Pain is the major symptom of Dyspareunia. This can be at the beginning of the vagina or deep inside the pelvis region, depending on the cause. Aching, burning and ripping sensations may also be felt by the woman.
What causes Dyspareunia?
Psychology also plays an important role in sexual intercourse. Women who are hesitant to have intercourse or have misconceptions about the act may not able to free up their muscles in their pelvis region which can make sex a painful thing. The hesitation or misconception can arise from their cultural backgrounds, upbringing, previous traumatic incidences etc. Anxiety, fear and stress can also lead to stiffness of muscles in the body and in the pelvis region.
Other physical reasons for painful sex/Dyspareunia can be:
- Dryness of Vagina – When a woman is sexually aroused, the vagina lubricates itself to allow smoother entry for penetrative sex. Insufficient lubrication can lead to painful sex. Dryness of vagina can be due to multiple reasons including menopause, lack of estrogen even when young, a short period of child birth or due to medications that are taken to treat other medical condition.
- Vaginismus – The muscles in the pelvis region contract involuntarily in some women. Freeing up of these muscles is important for normal intercourse to happen. The contraction of muscles can be due to psychological or medical reasons.
- Injury to the vagina or in the surrounding areas – Any injury or trauma in the pelvis region or directly to the vagina can also result in painful sex. The injury can be due to an accident or due to female genital mutilation or because of a recently undergone surgery such as hysterectomy.
- Postpartum Dyspareunia – From a few days to few weeks after child birth, women may have pain during sex. This happens in 50% of the cases and there is nothing much to worry about. You must see a gynecologist if the pain continues for more than few weeks.
- Congenital Defects – Some women, in very very few cases are born with genitals that are not fully formed or deformed. As the female child grows up, the defect still remains and they may not know until a doctor examines (usually for a different reason) or till they start having sex.
- Vaginal Infections – Infection in the vagina or in the urinary tract (Urinary Tract Infections) or if a woman has some Sexually Transmitted Infections, she may have pain while having intercourse.
- Problem with skin around the vagina – This can be a totally external problem where the skin itches, irritates due to conditions like eczema, lichen planus, lichen sclerosus etc.
Medical conditions that can cause Dyspareunia (painful sex)
When the pain is deep inside the pelvis region, most often the reason can be a bigger medical condition that needs to be addressed by a good gynecologist. Such medical conditions that can cause Dyspareunia include:
- Inflammation of the wall inside the bladder due to infection called Cystitis.
- Vulvodynia – Pain in the areas around the vagina, called Vulvar region.
- Endometriosis – Endometrium is the inner lining in the uterus. Women suffering from endometriosis present with the endometrium layer growing outside the uterus.
- Pelvic Inflammatory Disorder (PID) – Inflammation of any of the reproductive organs in a woman caused due to infection.
- Prolapse of the uterus – Uterine prolapse is a condition when the uterus descends into the vagina. In a normal woman’s body, the tissues and muscles in the pelvis region hold all the soft parts in their places. As these tissues and muscles lose strength due to various regions, they start falling ‘down’ and in some cases, they fall through the vagina, anus etc.
- Irritable Bowel Syndrome – a problem with the digestive tract.
- Uterine Fibroids – abnormal growth in or on the uterus. Mostly they are benign. (Non cancerous).
- Diabetes, Arthritis, Cancer, Thyroid issues can also hamper interest in sex.
- Birth control pills may also contribute painful sex. You need to talk to a doctor before you start putting yourself on birth control pills.
How is Dyspareunia diagnosed?
Most gynecologists start with questioning to ascertain the broad reason for Dyspareunia. They may ask for your medical history, cultural background, your previous sexual encounters etc. Then he/she may start with a physical examination to assess the condition of the organs inside the pelvis region. Your doctor may look for any infection, vaginal discharge, warts, rashes, abnormalities developed around the vagina etc. Anatomy of vagina will also be examined to look for any congenital defects.
Some other tests that your gynecologist may recommend include urine analysis test, allergic test, ultra sound of the pelvis, test for any vaginal infections etc.
Treatment of Dyspareunia
If the reason for Dyspareunia (or painful sex) is due to psychological reasons, your gynecologist may put you on to a therapist or a sexologist to clear your mind and help you get out of the misconceptions, fear or anxiety issues.
If the pain is caused due to infections of the vagina, urinary tract or any other part inside the pelvis region including sexually transmitted infection(s), you will be put on antibiotics to get rid of the infection. Recurring vaginal infection or urinary tract infection is a issue and you must let your gynecologist know about that. If the pain is due to vaginal dryness and because of hormone deficiency in your body, you may be put on ‘Hormone Replacement Therapy’ where you will be put on estrogen (and progesterone) supplements.
Pain during sex when having it for the first time or initially is very common and can be ignored. Persistent pain or pain after sex continuously has to be reported to your gynecologist to determine and treat the underlying cause.