Dyspareunia

Definition

This is an abnormal pain during sexual intercourse. It may result from abnormal conditions of the genitalia, dysfunctional psychophysiologic reaction to sexual union, forcible coition, or incomplete sexual arousal.

Description

Dyspareunia is pain that occurs only (or primarily) during sexual intercourse. It is not a disease, but rather a symptom of an underlying physical or psychological disorder.

The pain, which can be mild or severe, may appear in the genitals, the pelvic region, or the lower back. The condition is much more common among women.

Causes and Risk Factors

For women, causes include vaginismus, a psychological condition characterized by spasms of the vaginal muscles and insufficient vaginal lubrication; scars from an episiotomy (an incision made to facilitate childbirth); thinning and dryness of the vaginal wall due to estrogen deficiencies accompanying menopause, or breastfeeding; and inadequate foreplay.

Disorders that may cause pain upon deep vaginal penetration include:

• Pelvic inflammatory disease

• Ovarian cysts

• Endometriosis

• Varicose veins in the pelvis

• Ectopic pregnancy

Other causes include:

• Infections, such as sexually transmitted diseases, which may irritate the vaginal walls or the skin of the penis

• Bladder or other urinary tract disorders such as cystitis or urethritis

• Cancer in the sex organs or the pelvic region

• Arthritis, especially in the lower back

• Allergies to spermicides or to the latex in condoms and diaphragm

For men, the condition can result from such disorders as irritation of the skin of the penis due to an allergic rash; physical abnormalities of the penis, like a tight foreskin or a bowed erection; and infections of the prostate gland or testes.

Another frequent explanation for painful intercourse is thinning and drying of the vaginal tissue as menopause begins. This happens because the body is producing less and less of the estrogen that is needed to maintain moist vaginal tissue. As the vagina's ability to make its own mucus declines, it becomes itchy, dry, and painful, leading to discomfort during intercourse.

Symptoms

Symptoms include a burning, ripping, tearing, or aching sensation associated with penetration. The pain can be at the vaginal opening, deep in the pelvis, or anywhere between. It may also be felt throughout the entire pelvic area and the sexual organs and may occur only with deep thrusting.

Treatment

Treatment is aimed at identifying and properly treating the underlying disorder.

Medications are prescribed to treat infections, if they exist. If an allergy to latex is suspected, alternative methods of contraception should be considered. If the spermicide is causing discomfort, try a different brand or consider using alternate methods of birth control.

A water-based lubricant may help ease discomfort and friction. However, avoid oil-based lubricants, such as petroleum jelly, since they dissolve the latex in condoms and may actually promote infection.

Insertion of a graduated set of dilators into the vagina may be used to treat vaginismus. Pain during intercourse due to an episiotomy generally subsides over time. Psychological counseling may be advised if no underlying physical abnormalities can be identified.

Questions to Ask Your Doctor

What is causing the pain?

Is the condition allergy based?

Would estrogens help?

What is the best lubricant to use?

Will counseling help?