Dyspareunia

PAINFUL SEX

Recurrent and persistent genital pain associated with sexual intercourse. Dyspareunia and vaginismus (spasm of the public muscles of the lower vagina) are often linked.

FREQUENT SIGNS AND SYMPTOMS

Pain in the general area during sexual activity, including foreplay, intercourse or attempted intercourse. Pain may be mild or severe, and it may vary with different intercourse positions.

CAUSES

Physical causes include:

  • Infection of the genitals, including herpes and others involving the vagina, cervix, fallopian tubes or ovaries.
  • Pressure against the vaginal wall caused by scarring from operations or radiation’s treatment.
  • Tight episiotomy scar from vaginal repair after childbirth.
  •  A fibroid or other uterine tumor.
  • Tight epistotomy scar from vaginal repair after childbirth.
  • Endometriosis.
  • A hymen that is imperforate (not opened), torn or thicker than normal.
  • A bruised opening to the urethra.
  • Inadequate vaginal or condom lubrication.
  • Allergic reactions to diaphragms, condoms or contraceptive foams and jellies.
  • Dryness and thinness of the vaginal wall after menopause due to estrogen deficiency.
  • Fear of pregnancy.
  • Fear of injury to the unborn child during pregnancy.
  • Lack of sexual arousal and vaginal lubrication caused by inadequate or insufficient sexual foreplay, aversion to a sexual partner, fatigue or anxiety.
  • Lack of sexual experience or information.
  • Past sexual injury or psychological trauma.
  • Temporary lack of desire for a particular sexual partner.

RISK INCREASES WITH

  • Pregnancy and the postpartum period.
  • Stress, recent illness.
  • Fatigue or overwork.
  • Alcohol consumption.
  • Menopause.

PREVENTIVE MEASURES

  • Obtain prompt medical treatment if you symptoms of infection of the reproductive organs.
  • Discontinue use of contraceptive foams or jellies that produce allergic reactions.
  • Discuss the lack of sexual arousal with your partner, including ways to improve foreplay. Enlist your partner’s support and patience to overcome the problem. Use a water-based non-allergenic lubricant, if necessary.
  • Obtain professional counseling to resolve feelings about past sexual trauma.

EXPECTED OUTCOME

Depends on the cause. Medical disorders are usually curable with treatment. Psychological problems can often be cured with therapy, and interpersonal problems can improve with communication and patience.

POSSIBLE COMPLICATIONS
Damage to personal relationships, permanent inability to enjoy sexual experiences and loss of self-esteem.

MANAGEMENT
GENERAL MEASURES

  • Laboratory studies, such as Pap smear and culture of any vaginal discharge to diagnose any medical problem that can be treated.
  • Appropriate treatment will be directed to physical causes or psychological causes.
  • Sitz baths frequently relieve tenderness. Sit in a tub of lukewarm water for 10 to 15 minutes. Repeat baths as often as 3 or 4 times a day.
  • Use a nonprescription lubricant, such as baby oil or K-Y Lubricating Jelly, during sexual intercourse.
  • Instructions for exercises or techniques to dilate the vagina. They may involve use of fingers or dilators to condition the body and mind to the sensation of something being inserted into the vagina.
  • Try the different positions for sexual intercourse to discover new ones that might reduce penile penetration and be pain-free.
  • Treatment for psychological causes will vary depending on the needs of the patient. It can involve education about contraception, counseling to uncover hidden conflicts, sensate focus exercises and teaching of appropriate foreplay techniques.
  • In cases of vaginismus or episotomy scarring, a minor surgical procedure (e.g., perineoplasty) may relieve symptoms.