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Dyspareunia

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Introduction

Dyspareunia is a condition characterised by pain related to sexual intercourse. It can affect men and women but is more common in women with about 8-22% of women  worldwide having faced in their lives.

This pain can be immediately before, during or after sexual intercourse and can vary from a superficial burning or sharp pain to deep pelvic pain.

Dyspareunia is problematic as it can lead to reduced arousal and desire for sex, and anxiety associated with a sexual activity which can affect mental health and cause decreased self-esteem and relationship issues down the line.

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What are the Causes of Dyspareunia?

Both physical conditions and mental or emotional conditions can cause Dyspareunia.

  • Psychological causes: Sexual activity is strongly linked to emotional states, and variations in mood and state of arousal can cause dyspareunia. These include:
  1. Inadequate arousal or foreplay before initiation of penetration
  2.  Feelings of guilt or shame around sex
  3. Anxiety
  4. Depression
  5. History of sexual assault/ abuse

Vaginismus, or involuntary muscle spasms of the vagina, can also cause Dyspareunia and can make penetration difficult.

  • Physical Causes: Medical conditions which affect the vulva, vagina, cervix, or pelvic structures can cause dyspareunia. Depending on whether the pain is superficial, i.e. at entry or deep pain, the causes of Dyspareunia can vary.

Causes of entry pain

  1. Skin conditions which affect the vulva and genital skin like allergic dermatitis, eczema, local fungal infections or vulvodynia.
  2. Urinary tract infections can also cause burning pain and discomfort
  3. Atrophic vaginitis: decreased estrogen levels post- menopause can cause the vaginal epithelium to thin out and be dry, causing more discomfort and pain.
  4. Inadequate lubrication due to medications like antihistamines, isotretinoin, antidepressants.
  5. Congenital anomalies like an imperforate hymen, vaginal agenesis.
  6. Previous injury to the area due to surgery or childbirth.
  7. Infections such as Herpes, genital warts, yeast infections.
  8. Post radiation or chemotherapy changes.

Causes of deep pain

  1. Deep or throbbing pain can be caused by conditions affecting the cervix, uterus, ovaries or pelvic musculature
  2. Pelvic inflammatory disease
  3. Endometriosis
  4. Ovarian cysts
  5. Fibroids
  6. Previous pelvic surgery

What are the Symptoms of Dyspareunia?

The characteristic feature of Dyspareunia is pain immediately before, during, or after sexual intercourse.

The pain can be a superficial burning or sharp sensation which can occur on penetration or it can be a deep aching pain and can be worse in certain positions.

It may or may not be associated with vaginismus.

How is Dyspareunia Diagnosed?

Dyspareunia is a clinical diagnosis of exclusion. Your doctor may choose to perform multiple tests to find the cause of the symptoms.

First, your doctor will take a complete history, then they may do a pelvic examination to look for anatomic causes. Since a pelvic examination might be uncomfortable, your doctor will explain the procedure to you and help you get into a comfortable position.

Other tests can include a pelvic ultrasound, a Pap smear, or testing for any STIs.

How is Dyspareunia Treated?

Treatment of Dyspareunia depends on cause.

For those with psychogenic causes, psychotherapy or couples’ counselling can bring relief to symptoms.

  • ● Desensitization therapy
  • ● Cognitive behavioural therapy
  • ● Medications like antidepressants or anti anxiety medications can be used
  • ● Engaging in adequate foreplay prior to sexual intercourse

Secondary causes such as infections, post-inflammatory changes will depend on specific treatment.

  • ● Antibiotics, antivirals or antifungals might be prescribed to you if they find any infectious causes.
  • ● For those with atrophic vaginitis, estrogen supplementation as creams, rings or pessaries can be used.
  • ● Pelvic floor physical therapy can be beneficial for muscle spasms/ post-childbirth dyspareunia.
  • ● Surgery may be required for congenital anomalies, ovarian cysts, or for scar release from previous surgeries.

What is the Results of Dyspareunia Treatment?

Dyspareunia can be easily treated with the modalities mentioned above, and once the workup reveals the cause, treatment can be modified accordingly. Most people with dyspareunia go on to have healthy sex lives. Until the time treatment is effective, patients can try to engage in other forms of sexual activity which can be just as fulfilling.

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FAQ's

Can Dyspareunia and Menstrual Cycle be Related?

Yes, menstrual cycle can affect Dyspareunia with pain being cyclical and more severe before or during the menstrual period. Using hot packs, over-the-counter pain medications etc can help relieve this pain.

Can you Get Dyspareunia if you’ve Never had it Before?

Yes, even if you’ve had no history of Dyspareunia before, many causes can lead to Dyspareunia later. These can be psychological factors or secondary medical causes like infections, post radiation, childbirth or surgery changes which can cause Dyspareunia.

Can Males Get Dyspareunia?

Although it is rare, men can also get Dyspareunia and are usually associated with urinary tract infections. They can be diagnosed and treated with appropriate antibiotics.

Is There Any Age Limit to Dyspareunia?

Unfortunately, there isn’t an age limit to Dyspareunia. It can affect young women as much as older women. Older women especially post-menopausal women are more susceptible due to the loss of estrogen. This can easily be treated with estrogen supplementation or hormone replacement therapy.

What can Partners do to Help Ease Dyspareunia?

Not all sex has to be penetrative. To help ease the feelings of inadequacy and shame around Dyspareunia, couples can focus on pleasure that is not based solely on penetrative intercourse. They can also spend more time on foreplay and use water-based lubricants and experiment with positions which are more comfortable.

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