Dyspareunia or pain during sex intercourse

Dyspareunia or pain during sex intercourse – Cause and Treatment

Dyspareunia is defined as the pain during sexual intercourse, and can affect both men and women. The American Academy of Family Physicians states that over 20% of American women are complaining of dyspareunia at some time during their life, which outlines the importance of this topic.

Usually, women with dyspareunia complain of an intense and sharp pain that becomes apparent on penetration, but this classical picture can be accompanied by other symptoms such as:

  • Vaginismus (a significant contraction of pelvic muscles during penetration);
  • Superficial or intense pain of the clitoris, labia or vaginal introitus;
  • Lack of sexual desire caused by the fear of pain;
  • Pain when inserting a tampon or during a gynecological examination;
  • Emotional discomfort;
  • Fear of intimacy or of pregnancy, negative body image, irritability;

Causes of dyspareunia:

  • Vaginal dryness: caused by menopause, pregnancy, lack of sexual prelude, certain drugs, etc;
  • Genital lesions;
  • Post vaginal birth;
  • Vulvo-vaginal inflammatory conditions;
  • Urinary tract infections;
  • Dermatological disorders (e.g. lichen planus);
  • Irritation or allergic reaction to substances used in female menstrual and hygiene products;
  • Congenital malformations (e.g. imperforate hymen);
  • After surgical interventions, chemotherapy or radiotherapy in the pelvic area;
  • Endometriosis;
  • Uterine fibroids;
  • Uterine prolapse;
  • Inflammatory pelvic disease;
  • Ovarian cysts;
  • Depression or anxiety disorders;
  • Sexual abuse;

The diagnosis of dyspareunia is established based on clinical manifestations declared by the patient and documented during gynecological consult;

Treatment of dyspareunia:

The treatment is both etiological- meaning that it concerns the primary cause, and symptomatic.

Adequate prelude, use of lubricants, Kegel exercises, clitoral stimulation before the actual intercourse may prove beneficial for the patients. Vaginal infections and inflammation must be treated accordingly to the results of laboratory tests with antibiotics, antimycotic or antiviral drugs. Some topical corticosteroids or estrogens may be needed for dermatological or inflammatory disorders of the vulva.   

Surgical intervention may be offered for the treatment of endometriosis, uterine fibroids, or ovarian cysts.

Cognitive behavioral therapy or meditation can be beneficial for the treatment of emotional background that lead to dyspareunia.

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