What is Dyspareunia?
Dyspareunia is a term that describes pain during intercourse. It can be experienced by either men or women immediately prior, during, or just after sexual intercourse.
Dyspareunia pain can originate anywhere in the genital area. For women pain is usually centered around the clitoris, labia, or vagina, and is described as stinging, burning, cramping, or a sharp pain. In men, pain is typically experienced during penetration, with erection, during ejaculation, or after sexual activity.
Pain during or after intercourse can negatively impact an individual's sex drive and desire to engage in sexual activity.
What Causes Dyspareunia?
There are many potential causes of Dyspareunia:
- Vulvodynia - chronic pain in the form of pain, burning, or irritation in the area around the opening of your vagina (vulva), with no identifiable cause
- Vestibulodynia - chronic pain of the vulva in the absence of vulvar or vaginal infection or skin disease
- Pelvic Inflammatory Disease - inflammation of the female genital tract, accompanied by fever and lower abdominal pain
- Genital or Pelvic Tumors
- Ovarian Cysts
- Urethritis - inflammation of the urethra
- Urinary Tract Infection
- Interstitial Cystitis -chronic condition of uncomfortable bladder pressure, bladder pain, and sometimes pain in the pelvis. The pain ranges from mild burning or discomfort to severe pain.
- Vaginal Atrophy - inflammation and/or thinning of the vaginal walls due to declining estrogen levels
- Insufficient lubrication (due to not enough foreplay or hormonal issues)
- Childbirth Trauma
- Radiation Therapy
- Genital infection or irritation
- Skin conditions (i.e. eczema)
- Medication side effects
- Pelvic examinations
- Surgical alteration of genitals/genital mutilation
- Bartholin's Cyst - a swollen fluid-filled lump that develops from a blockage of one of the Bartholin's glands, which are small glands on each side of the vaginal opening
- Uterine prolapse or retroverted uterus
- Prostatitis - swelling and inflammation of the prostate gland
- Emotional distress
In some cases a history of sexual abuse is associated with dyspareunia.
How is Dyspareunia Diagnosed?
Dyspareunia is diagnosed by a qualified gynecologist who has training and familiarity with pain issues. A pelvic examination will be performed to check for tenderness, tension, skin issues, and to identify any anatomical issues. Cultures of vaginal fluids may be taken to diagnose infection or other medical issues. If a physical problem is suspected to be the underlying cause of the dyspareunia, additional tests may be ordered.
Further, a history will be taken regarding pain symptoms, onset, and marital or sexual history. The more information you are able to provide to the physician regarding symptoms and circumstances during the onset of pain, the better the chances of a correct diagnosis. If both partners are open to it, it is suggested that you see the doctor together with your partner.
How is Dyspareunia Treated?
There are several treatment recommendations for those who suffer with Dyspareunia, some of which may depend on the cause of the pain. It is best to discuss your options and work with your physician to develop a treatment plan. In general, this may include changes in sexual technique or practices, counseling, desensitization therapy, and/or medication. Until you have found a treatment that works for you, you and your partner may be able to stay connected by focusing on intimate activities beyond intercourse.
For women who have pain with intercourse shortly after pregnancy or due to hormonal issues:
- Be patient with your body
- Be gentle with your body
- Use lubrication as needed
- Wait at least six weeks postpartum to resume intercourse
- Discuss the potential of menopause treatments, if appropriate
For men, if prostatitis is the cause:
- Soak in a warm bath
- Drink fluids (not alcohol or caffeine)
- Take over-the-counter pain medication
- Take antibiotics as recommended by a doctor
When hemorrhoids are present, stool softeners may decrease pain. Antibiotics treat infection, urinary tract infections, and sexually transmitted diseases.
It is also important to recognize that you must take care of your body. Hygiene and medical care are important, as are adequate foreplay and stimulation.
Irritation is also often caused by excessive washing with soap. This causes skin irritation in the sensitive areas of the genital regions. If skin irritation is present, a cortisone cream can reduce irritation.
Vaginismus.com is a resource for vaginismus specifically, but also for vaginal and pain-related disorders.
The Mayo Clinic provides an excellent overview article on dyspareunia, its possible causes, symptoms, and treatment.