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Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Dyspareunia is the medical term for recurring pain in the genital area or within the pelvis during sexual intercourse. The pain can be sharp, or intense, and can occur before, during, or after sexual intercourse. Dyspareunia is more common in women than men. It has many possible causes, but it can be treated.
CAUSES
Several conditions can cause dyspareunia. For some women, it’s a sign of a physical problem. Other women may experience pain as a result of emotional factors. Common physical causes of dyspareunia include:
* Vaginal dryness from menopause, childbirth, breastfeeding, medications, or too little arousal before intercourse
* Skin disorders that cause ulcers, cracks, itching, or burning
* Infections, such as yeast or urinary tract infections (UTIs)
* Injury or trauma from childbirth, an accident, an episiotomy, a hysterectomy, or pelvic surgery
* Vulvodynia, or pain centred in the vulva area
* Vaginitis, or inflammation of the vagina
* Vaginismus, or a spontaneous tightening of the muscles of the vaginal wall
* Endometriosis
* Cystitis
* Pelvic inflammatory disease (PID)
* Uterine fibroids
* Irritable bowel syndrome (IBS)
* Radiation and chemotherapy
Sex problem. Disappointed black unsatisfied woman lying in bed, sad man looking under blanket, top view RISK FACTORS
Factors that reduce sexual desire or affect a person’s ability to become aroused can also cause dyspareunia. These factors include:
* Stress, which can result in tightened muscles of the pelvic floor
* Fear, guilt, or shame related to sex
* Self-image or body issues
* Medications such as birth control pills
* Relationship problems
* Conditions such as cancer, arthritis, diabetes, and thyroid disease
* History of sexual abuse or rape
SYMPTOMS
Dyspareunia pain can vary. Pain may occur:
* In the vagina, urethra, or bladder
* During penetration
* During or after intercourse
* Deep in the pelvis during intercourse
* After pain-free intercourse
* Only with specific partners or circumstances
* With tampon use
* Along with burning, itching, or aching
* With a feeling of stabbing pain, similar to menstrual cramps
RISK GROUPS
Both women and men can experience dyspareunia, but the condition is more common in women. Dyspareunia is one of the most common problems of postmenopausal women. Around 75 percent of women have painful intercourse at some time, according to the American College of Obstetricians and Gynecologists (ACOG). They are at an increased risk if they:
* Take medications that cause vaginal dryness
* Have a viral or bacterial infection
* Are postmenopausal
DIAGNOSIS
Several tests help doctors identify and diagnose dyspareunia. Doctors would start by creating a complete medical and sexual history. Possible questions asked may include:
* When and where does the pain occur?
* Which partners or positions cause pain?
* Do any other activities cause pain?
* Does partner(s) feel pain as well, and need help?
* Are there other conditions that may be contributing to the pain?
* A pelvic examination is also common in diagnosis. During this procedure, doctors would look at the external and internal pelvic area for signs of:
o Dryness
o Inflammation or infection
o Anatomical problems
o Genital warts
o Scarring
o Abnormal masses
o Endometriosis
o Tenderness
The internal examination would require a speculum, a device used to view the vagina during a Pap test. A cotton swab may also be used to apply slight pressure to different areas of the vagina. This would help determine the location of the pain. The initial examination may lead doctors to request other tests, such as:
* Pelvic ultrasound
* Culture test to check for bacteria or yeast infection
* Urine test
* Allergy test e.g., latex or lubricant gels, which is often common in many women
* Counselling to determine the presence of emotional causes
TREATMENT
* Medications
Dyspareunia treatments are based on the cause of the condition. If the pain is caused by an underlying infection or condition, doctors may treat it with:
* Antibiotics
* Antifungal medicines
* Topical or injectable corticosteroids
If a long-term medication is causing vaginal dryness, the physician may change the prescription. Trying alternative medications may restore natural lubrication and reduce pain.
Low estrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of estrogen to the vagina.
An estrogen-free drug called ospemifene (Osphena) acts like estrogen on vaginal tissues. It’s effective in making the tissues thicker and less fragile. This can reduce the amount of pain a woman experiences during sexual intercourse.
* HOME CARE
These home remedies can also reduce dyspareunia symptoms:
* Use water-soluble lubricants.
* Have sex when both partners are relaxed.
* Communicate openly with one’s partner about the pain and the experience.
* Empty the bladder before sex.
* Take a warm bath before sex.
* Take an over-the-counter pain reliever before sex. Find a selection of pain relievers online.
* Apply an ice pack to the vulva to calm the burning after sex. Shop for ice packs.
ALTERNATIVE THERAPIES
This can include desensitisation therapy or sex therapy. Desensitisation therapy teaches vaginal relaxation techniques, such as Kegel exercises, which can decrease pain.
In sex therapy, people can learn how to re-establish intimacy and improve communication with their partners.
PREVENTING DYSPAREUNIA
There’s no specific prevention for dyspareunia, but persons can do the following to reduce the risk of pain during intercourse:
* After childbirth, wait at least six weeks before resuming sexual intercourse.
* Use a water-soluble lubricant when vaginal dryness is an issue.
* Use proper hygiene.
* Get proper routine medical care.
* Prevent sexually transmitted diseases (STDs) by using condoms or other barriers.
* Encourage natural vaginal lubrication with enough time for foreplay and stimulation.
Alternatives to sexual intercourse may be useful until underlying conditions are treated. Partners can use other techniques for intimacy until penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual masturbation may be satisfying alternatives.
