Dyspareunia

There are numerous explanations for why some women experience pain during intercourse. Reasons range from the physical to the psychological. The medical term for intercourse pain is dyspareunia. Dyspareunia is the condition of persistent or recurring genital pain before, during or after intercourse.

Physical factors

Symptoms

• Pain at the point of sexual penetration (entry)
• Pain with every penetration, even while inserting a tampon
• Pain under certain conditions or circumstances
• New pain after previously pain-free intercourse
• Deep pain during thrusting, which is often described as “something being bumped”
• Burning or aching pain

 

The pain a woman feels is closely tied to her emotions. What may be a minor discomfort for one person may feel like extreme pain for another. The following reasons play a part: a previous traumatic sexual experience such as rape, fear of pregnancy, a negative self-image, anger towards their partner, or believing the pain will never leave.

Causes

1)  Superficial or Entry Pain:

Superficial pain is usually felt around the vaginal opening (vulva or genital area). Causes include:

• Insufficient lubrication. Most often this can be remedied with more foreplay. This condition also occurs when estrogen levels drop after childbirth, during breast feeding or once menopause hits. Some medications such as sedatives, antihistamines, antidepressants and some birth control pills are known to restrain arousal or desire which decreases lubrication, making intercourse painful.
• Injury, trauma or irritation. This could be from an injury caused by an accident, pelvic surgery, female circumcision, episiotomy or a congenital abnormality.
• Inflammation, infection or skin disorder. An infection in the genital area or urinary tract can cause superficial pain. Genital area skin problems such as eczema can also heighten the condition, as well as allergic reactions to certain jellies, foams or latex condoms.
• Vaginismus. This is the involuntary spasms of the muscles of the vaginal wall, which can make penetration very painful.
• Congenital abnormality. For example, an abnormal partition within the vagina that interferes with the penetration of the penis.

 

The hymen is a membrane that encircles or, for some women, covers the vagina opening. When women have sex for the very first time, the hymen, if not previously stretched from say, tampon usage or sexual stimulation with a finger inside the vagina, may tear, causing bleeding and pain.

 

2)  Deep Pain:

Deep pain may be felt within the pelvis in certain positions or when the penis is thrust further inside. The pain is described as sharp, cramping or burning. If it is intensified when the pelvic muscles become tight. If genital organ disorders or vaginal dryness is present, the pain increases. After a pelvic examination, a diagnosis can be made. Causes include:

• Certain conditions or illnesses. Includes ovarian cysts, irritable bowel syndrome, hemorrhoids, pelvic inflammatory disease (infection of the cervix, uterus, or fallopian tubes) , endometriosis, uterine prolapse, retroverted uterus, uterine fibroids, and cystitis may cause collections of pus or abscesses to form in the pelvis, causing the act of intercourse painful.
• Surgeries or medical treatments. Surgeries such as hysterectomies that involve your pelvic area which produces scarring can sometimes cause painful intercourse. Some medical treatments for cancer like radiation and chemotherapy, can cause physiological changes that could also make sex painful.

 

Some conditions such as fibroids cause retroversion. This is when the uterus becomes stuck in a bent-backward direction, which causes deep pain. Pelvic muscle hyper-tonicity, which is strong involuntary pelvic muscle contraction can also cause or result from deep pain.

 

Emotional factors

Sex is not just a physical act. The emotions are involved and therefore play a part in experiencing sexual pain. Some emotional factors include:

• Psychological problems. This could range from depression, anxiety, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and as a result, pain or discomfort.
• Stress. When one is stressed, the pelvic floor muscles tend to tighten up, hence possibly making intercourse painful.
• Sexual abuse. Any negative emotional trigger connected with the sexual act may play a role in making sex painful.

 

Sometimes, a cycle begins when a woman experiences pain during the first time she has intercourse. This memory can lead to a fear of recurring pain, which may make her feel anxious, tightening up her body, which then leads to more pain. The body remembers pain quite acutely, and thus may send messages to the brain to avoid any activities associated with that pain.

 

Diagnosis

Two factors are considered in making a diagnosis: the symptoms–woman’s description of the problem including when and where the pain is felt–and results from a pelvic exam. The physical examination may involve the following:

• By using a cotton swab, the doctor touches the area gently to check for any indications of pain.
• The doctor can also check for pelvic muscle tightness around the vagina by inserting one or two gloved fingers into the vagina
• To check the ovaries and uterus, the doctor places their other hand on the lower abdomen.
• At times, a rectal exam may also be conducted.

 

If the doctor finds inflammation or an abnormality, they may request a biopsy (samples being examined under a microscope).

Treatment

1)  For Superficial Pain:

• taking sitz baths
• applying anesthetic ointment
• applying lubricant liberally before intercourse (water-based rather than petroleum/oil-based)
• exercises to relax pelvic muscles
• increasing amount of foreplay
• In some cases, the surgical removal of all remaining hymen tissue.

 

2) For Deep Pain:

• changing the position of intercourse. For example: allowing the woman to be on top. This gives them more control of penetration or any other position that can limit how deep the penis is able to thrust
• Specific treatments depending on the cause. For example;
• If the vagina is thinned or dry because of menopause, hormone therapy such as estrogen insertion into the vagina or another topical or oral treatment may be administered
•  For infections, antibiotics, antifungal drugs or the like can be appropriated
  • Surgery to remove abscesses or cysts or to correct a rigid hymen or congenital abnormality

 

3) For Emotional Pain:

• seeing a counselor or a psychologist
• mindfulness-based cognitive therapy: involves focusing on the present moment without projecting previous pain onto the current situation.
• Inner healing prayer sessions.