Dyspareunia is a medical term for painful intercourse. It can affect women of any age, but it is more common in women who are postmenopausal, breastfeeding, or have certain medical conditions. Dyspareunia can have a negative impact on a woman's quality of life, sexual satisfaction, and relationship with her partner.
Causes of Dyspareunia
Dyspareunia can have various physical or psychological causes, or a combination of both. Some of the common causes are as follows:
- Vaginal dryness - This can result from hormonal changes due to menopause, childbirth, breastfeeding, or certain medications. It can also be caused by insufficient arousal before intercourse, which may be related to stress, anxiety, or relationship issues.
- Skin disorders - Some skin conditions that affect the vulva (the external female genitalia) can cause itching, burning, ulcers, or cracks that make intercourse painful. These include eczema, psoriasis, lichen sclerosus, and lichen planus.
- Infections - Infections of the vagina (such as yeast infections or bacterial vaginosis) or the urinary tract (such as cystitis or urethritis) can cause inflammation and irritation that make intercourse painful. Sexually transmitted infections (such as herpes, gonorrhoea, or chlamydia) can also cause ulcers or sores that make intercourse painful.
- Vaginismus - This is a condition where the muscles of the vagina involuntarily contract and spasm when penetration is attempted. This can make intercourse impossible or very painful. Vaginismus can be triggered by fear, trauma, anxiety, or past sexual abuse.
- Pelvic problems - Some conditions that affect the pelvic organs (such as the uterus, ovaries, fallopian tubes, or bladder) can cause pain during intercourse. These include endometriosis, ovarian cysts, pelvic inflammatory disease, interstitial cystitis, fibroids, and pelvic floor dysfunction.
- Congenital anomalies - Some women are born with abnormalities of the vagina or the hymen (the thin membrane that partially covers the vaginal opening) that can make intercourse painful. These include vaginal agenesis (absence of a vagina), imperforate hymen (a hymen that completely blocks the vaginal opening), or septate hymen (a hymen that has a band of tissue dividing the vaginal opening).
- Anxiety - Anxiety about sex can interfere with arousal and lubrication, and cause muscle tension that makes intercourse painful. Anxiety can stem from various factors, such as performance pressure, body image issues, low self-esteem, or past sexual trauma.
- Depression - Depression can affect a woman's mood, libido, and interest in sex. It can also affect her ability to experience pleasure and orgasm during sex. Depression can be caused by various factors, such as stress, trauma, hormonal changes, or chronic illness.
- Relationship problems - Relationship issues with one's partner can affect a woman's emotional intimacy and trust in sex. These can include lack of communication, conflict, infidelity,
- abuse, or dissatisfaction with the sexual relationship.
Symptoms of Dyspareunia
The symptoms of dyspareunia vary depending on the cause and location of the pain. Some women may experience pain only at the entrance of the vagina (entry pain), while others may experience pain deeper in the pelvis (deep pain). Some women may experience pain with every penetration attempt (including inserting a tampon), while others may experience pain only with certain positions or partners. The pain may be described as
The pain may occur just before, during, or after intercourse. It may last for a few minutes or for several hours after intercourse.
Treatment Options for Dyspareunia
The treatment for dyspareunia depends on the underlying cause and severity of the pain. The first step is to consult a health care provider who can diagnose the cause and recommend appropriate treatment options. Some of the possible treatment options are:
- Lubricants - Using a water-based lubricant before and during intercourse can help reduce friction and irritation caused by vaginal dryness. Avoid using oil-based lubricants (such as petroleum jelly or baby oil) as they can damage latex condoms and increase the risk of infection.
- Moisturisers - Using a vaginal moisturiser regularly can help restore moisture and elasticity to the vaginal tissues. Unlike lubricants, moisturisers are absorbed by the skin and provide longer-lasting relief. They are available over-the-counter in pharmacies or online.
- Hormone therapy - For women who have vaginal dryness due to menopause or other hormonal changes, hormone therapy may help improve lubrication and reduce pain. Hormone therapy can be administered in various forms, such as pills, patches, creams, gels, rings, or pellets inserted under the skin. Hormone therapy has some risks and side effects, such as increased risk of blood clots, stroke, breast cancer, and heart disease, so it should be used under the guidance of a health care provider.
- Topical medications - For women who have skin disorders or infections that cause vulvar pain, topical medications may help relieve symptoms. These include creams, ointments, gels, or suppositories that contain anti-inflammatory, antibacterial, antifungal, or anaesthetic agents. These medications are usually prescribed by a health care provider and should be used as directed.
- Oral medications - For women who have pelvic problems that cause deep pain, oral medications may help reduce inflammation, infection, or nerve pain. These include antibiotics, anti-inflammatory drugs, antidepressants, anticonvulsants, or opioids. These medications are usually prescribed by a health care provider and should be used as directed.
- Physical therapy - For women who have vaginismus or pelvic floor dysfunction that cause muscle spasms or tightness, physical therapy may help relax and strengthen the pelvic muscles. Physical therapy may involve exercises, massage, biofeedback, electrical stimulation, or dilators (graduated plastic tubes inserted into the vagina to stretch it). Physical therapy is usually performed by a trained physical therapist who specialises in pelvic health.
- Psychotherapy - For women who have psychological issues that affect their sexual function and satisfaction, psychotherapy may help address their emotional and mental health. Psychotherapy may involve individual counselling, couples counselling, or sex therapy with a licensed therapist who has experience in treating sexual problems. Psychotherapy may help improve communication skills, self-esteem, body image, trauma resolution, and sexual education.
- Surgery - For women who have congenital anomalies that prevent penetration or cause severe pain, surgery may be an option to correct the abnormality. Surgery may involve removing excess tissue (such as an imperforate hymen), creating an opening (such as for vaginal agenesis), or reconstructing the vagina (such as for severe scarring). Surgery is usually performed by a gynaecologist who specialises in pelvic surgery.
Dyspareunia is a common condition that affects many women at some point in their lives. It can have various causes and symptoms that require different treatment options. If you are experiencing painful intercourse, do not suffer in silence. Seek help from a health care provider who can diagnose your condition and offer you effective treatment options. You deserve to enjoy sex without pain.