Dyspareunia

Dyspareunia - pain with intercourse

Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia.

Pain during sexual intercourse or during menstruation are common conditions. Sometimes these conditions, known as dyspareunia (pain during intercourse) and dysmenorrhea (pain during menstruation), are due to a retroverted uterus or a prolapsed uterus.

Dyspareunia and dysmenorrhea as well as other related conditions can cause physical as well as emotional distress and can effect intimate relationships.

Diagnostic criteria of Dyspareunia

• The patient often experiences genital pain with sexual intercourse.
• It is due neither to Vaginismus nor inadequate lubrication.
• Except for another Sexual Dysfunction.
• It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.
• It causes marked distress or interpersonal problems.

Biopsychosocial Approach of Dyspareunia

This integrated pain model emphasizes that physical and psychologic factors may be instigating causes and reasons for perpetuation of the symptoms. The optimal approach incorporates social learning and operant conditioning models with pain, psychologic and physical conditions. The Learning theory suggests that erroneous or negative expectations of sexual intercourse are the result of absent or faulty learning. The Developmental theory examines the impact of early influences on the formation of negative attitudes. The Operant Conditioning model supposes that negative events occur (i.e., a woman has a painful sexual experience), which then cause a conditioned negative response. This result leads to further dissatisfaction and decreased response, and sexual activities then become painful. In the Operant Conditioning theory, the woman does not initially present with a set of negative expectations, feelings or attitudes.

What is causes of Dyspareunia?

There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious. But a few are. So again, you need to get yourself assessed soon.

How can my doctor tell what is causing my pain?

Your doctor may ask you to describe your pain, when it began and any associated problems, and may ask you to describe what you have tried in the past. For example, is it painful every time you try to have sex? Are there other problems associated with sex? These are some of the questions that your doctor will need to discuss with you. Your doctor may want to examine your genital area.

Dyspareunia - Psychologic Issues and Considerations

Psychologic theory historically treats dyspareunia as a symbol of unconscious conflict, stemming from phobic reactions, major anxiety conflicts, hostility or sexual aversions. The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), defines dyspareunia as a sexual pain disorder, a subcategory of sexual dysfunction. Dyspareunia is differentiated from vaginismus or problems resulting from inadequate lubrication. The pain must be persistent or recurrent, and cause marked distress or interpersonal difficulty. In one study, only the onset of pain and its location were useful discriminators.

Treatment of Dyspareunia

Examination of both partners before marriage or sexual activity; a frank explanation of the reproductive and sexual organs, their functions, and the physiologic and psychologic factors involved in sexual intercourse; and guidance in sexual techniques may prevent problems. Most important is listening to the partners' concerns and answering their questions. Existing lesions or defects should be corrected, if possible. For example, a tight hymenal ring may be stretched in the physician's office. An anesthetic ointment (eg, 1% lidocaine) should be used before each treatment.

Relaxation exercises may help a woman regain control over vaginal muscles, reducing pain and making sexual intercourse more pleasurable.

Educational discussions with both partners is recommended. However, if dyspareunia is long-standing or if the underlying psychologic factors cannot be corrected, the patient should be referred to a psychiatrist.

Prognosis of Dyspareunia

Many causes of dyspareunia are rooted in a physical condition that can be cured or controlled with proper medical care. However, women with longstanding dyspareunia or a history of sexual abuse or trauma may need counseling to alleviate the symptoms.

When To Call A Professional

Although sexual intercourse may be uncomfortable the very first time, it should never be painful. If you suddenly begin having pain before, during or after intercourse, see your doctor. It is important to seek care early, before you begin to avoid sexual intercourse or feel anxious in anticipation of your partner.

Prevention of Dyspareunia

• Good hygiene and routine medical care will help to some degree.
• Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
• The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant since it is not water soluble and may encourage vaginal infections.
• Practicing safe-sex can help prevent sexually transmitted diseases.

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Site last updated: March 4, 2008

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