Dyspareunia or pain during intercourse is associated with sexual pain disorders which are perhaps the most extreme symptoms of female sexual dysfunction. Dyspareunia is simply any recurrent or persistent urogenital pain that is associated with sexual activity and may occur upon penetration, during intercourse and/or following intercourse. The term is usually used to describe pain on penetration, but it can occur during genital stimulation.
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Dyspareunia is best described according to the location of the pain. The pain can be anywhere in the woman's perineum like in the vaginal opening or deep inside the pelvic area and comes with various qualities and patterns (e.g., as an acute stabbing sensation on contact, or a chronic throbbing pain that surges and ebbs throughout the day).
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The majority of sexual pain for women falls into one of two categories which are superficial dyspareunia (involving the vulva, the introitus and the lower third of the vagina) and deep dyspareunia (when it is felt near the cervix or the lower abdominal area).
Superficial Dyspareunia
Superficial vulval and vagina pains are common and have many causes. Occasionally, pain may occur in one or more spots, either in the vagina or the vulva. This may be a site of a scar, hymenal thickening, or chronic gland enlargement. Among the most common of these female sexual pain disorders are vulvodynia, vulvar vestibulitis and vagina pain.
Vulvodynia
Vulvodynia is defined as a noncyclic, chronic vulvar discomfort extending to the urethral and rectal areas, characterized by the patient's complaint of chronic pain, burning, rawness, stinging, or itching. If a woman has this condition, she might feel discomfort only when she attempt sexual activity, or the pain might be constant (or intermittent) and not restricted to sexual activity.
For some women sexual arousal by itself, without penetration or even physical contact, can cause pain because of the vasocongestion that occurs in the genital region. Light touch of the vulvar area often exacerbates the ongoing pain. A recent study estimated that vulvodynia affects 6-7% of women in the general population, with a higher prevalence in women over the age of 30.
Vulvar Vestibulitis
Vulvar vestibulitis is a subset of vulvodynia that happens in a very specific part of the vulva. The vulvar vestibule starts at the hymenal ring and blends with the labia minora. Within this area, some women have distinct points of tenderness. Women with vulvar vestibulitis typically experience a severe sharp, burning pain localized at the entrance of the vagina (i.e., the vulvar vestibule). This pain occurs upon contact, through both sexual and nonsexual stimulation.
Vulvar Vestibulitis is generally due to conditions of inflammatory origin or as some controlled investigations suggest, due to an altered pain processing that plays a role in the development and/or maintenance of vulvar vestibulitis. It is also believed to be the most common form of painful intercourse in premenopausal women, affecting an estimated 12% in the general population.
Vaginal pain
The vagina has no light touch sensation. Vaginal pain is the least common category of dyspareunia, partly because sensory nerve endings are present only in the lower third of the vagina. Pain is mainly experienced at the entrance to the vagina.
Deep Dyspareunia
Deep dyspareunia is often referred to as pelvic pain or deep thrusting pain. It is a condition where pain results from pelvic thrusting during sexual intercourse. Pain with deep penetration may have a structural or psychological cause.
Causes of dyspareunia
A very common cause of sexual pain is vaginal dryness. The excitement phase of the sexual response cycle prepares the vagina for penetration by providing lubrication for the genitals. Lack of adequate lubrication can cause friction leading to pain, irritation, and rawness at the opening of the vagina. The walls of the vagina can also be irritated by penetration if lubrication is insufficient.
Causes of vagina pain therefore naturally include lubrication difficulties; lack of knowledge of sexual response; lack of arousal; urethral problems; postmenopausal atrophy; infectious or irritative vulvitis and vaginitis; intercourse too soon after surgery or childbirth; and psychological concerns mostly emanating from sexual traumas.
Pain in a specific area of the vulva or vagina could be as a result of hymenal ring difficulty/thickening; old scars, lesions, abscesses, chronic gland enlargement; genital herpes; intercourse too soon after surgery or childbirth; and infectious or irritative vulvitis and vaginitis.
Deep dyspareunia could result from several causes among which are masses or uterine enlargement; endometriosis; pelvic infection; postoperative adhesions; ovarian tumours or cysts; vaginismus and psychological concerns. Although retrograde uteruses have been said to cause dyspareunia, no proof supports this. Also, a very common cause is positional, with deep thrusting by the woman's partner hitting an ovary.
Treatment of Dyspareunia
A lot of women experience pain for a variety of different reasons. Treatment would therefore be based on defining the probable cause of the dysfunction and these are often a blend of physical and psychological factors. When the problem is medical and can be identified, treatment tends to be fairly straightforward.
For pain due to inadequate lubrication, education about normal sexual functioning and the need and time for lubrication may help couples increase the pleasure of their sexual experiences. The use of over-the-counter supplemental water-soluble lubricant such as K-Y Jelly can help make sex more comfortable.
Postmenopausal vaginal atrophy can cause diminished vaginal lubrication; hormone replacement therapy is often the recommended choice of treatment. The additional use of vaginal cream containing estrogen if not contraindicated, may also help. In menopausal women, the addition of testosterone to the therapy provides additional benefits.
Pain in a specific area of the vulva or vagina requires a physical examination to discover the area and for appropriate treatment and medication to advocated. To reduce the risk of yeast infection, women should avoid tight clothing, wear cotton underpants and practice good hygiene.
It is worthwhile to note that some women have no specific disorder but always experience pain when the penis hits the cervix; this situation can only be avoided by less deep penetration which can be effected by a change in sexual positions, side-to-side or with woman on top, or using a pillow under her buttocks. Also, if the pain is deep in the pelvis, the cause may be a pelvic infection, endometriosis, ovarian tumour or cysts, or some other condition that should be investigated by a physician.
If no underlying medical cause is identified in a woman with dyspareunia, sex therapy may be helpful. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which need to be worked through in therapy. It may be best for both partners to see the therapist together. However, if dyspareunia is long-standing or if the underlying psychological factors cannot be corrected, the patient should be referred to a psychiatrist.
Prevention of Dyspareunia
1. Good hygiene and routine medical care will help to some degree.
2. Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water-soluble, and it may encourage vaginal infections.
3. Practicing safe sex can help prevent sexually transmitted diseases.
Causes and Treatment of Female Sexual Pain Disorder
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