Dyspareunia

Do you suffer from painful sensations during sex? If yes, there is high probability that you are suffering from a sexual disorder known as Dyspareunia. Know all about the causes, symptoms, diagnosis and treatment of this disorder.

Dyspareunia Definition

It is a persistent or recurrent genital pain that occurs during sexual intercourse. The pain usually occurs immediately before or after the intercourse or even during copulation.

The condition mainly affects females although it has also been reported in some men.

Dyspareunia ICD 9 Code

The ICD 9 Code for this disorder is 625.0.

Dyspareunia Incidence

The exact incidence of this condition is not known. However, one-fifth of all women are said to be affected by it at some time of their lives. According to a recently conducted research, around 15% women occasionally suffer from painful intercourse every year. As per the same study, the condition is more frequent in 1-2% adult women. In women, the prevalence of the disease has been estimated to be 14% with slight variations in the lifespan of sufferers. It is found to occur mostly in women aged between 18 and 24 years. In men, the condition is believed to have a 3% prevalence rate. Prevalence has been estimated to be higher in men who indulge in receptive anal intercourse.

Dyspareunia Types

The condition can be classified into three types, based on the intensity of pain reported by sufferers. These are:

Superficial Dyspareunia

It is generally secondary to anatomic problems and arises along with attempted penetration.

Vaginal Dyspareunia

It is marked by pain associated with problems in lubrication and includes arousal disorders.

Deep Dyspareunia

It is often related to pelvic disorders and is characterized by painful sensations associated with thrusting.

Collision Dyspareunia

It is a painful sensation experienced deep inside the pelvic region during sexual intercourse. It occurs at the time of penetrative sex when the penis of the male strikes the cervix at the deepest thrust. Pain is experienced when the tip of the penis strikes the cervix, or its adjoining tissue, very hard.

Dyspareunia Symptoms

As already mentioned, the condition is primarily characterized by pain. Pain might be accompanied by other bodily discomforts such as tearing, ripping, aching or burning sensations during intercourse. Pain can originate at the opening of the vagina, in the deep pelvic area or any region in between.

Pain may be felt in the whole pelvic region as well as the sexual organs in case of deep thrusting.

Sufferers may feel pain only at the time of penetration or during thrusting or even while wearing a tampon. The pain may be a burning or aching sensation. The sensation may be experienced only with some partners or only in some circumstances.

In women, the painful sensations can reduce excitement or pleasure during sexual intimacy. Vaginal dilation as well as vaginal lubrication tends to decrease. A dry and undilated vagina leads to pain during thrusting of the penis.

In some cases, women experience pain even after the original cause of aches is not there anymore.

Male Dyspareunia

In men, the condition can arise from problems like:

  • Irritation of the skin on the penis, which can be caused due to an allergic rash
  • Bowed erection, tight foreskin or any other structural abnormalities of the penis
  • Infection of the testes or the prostate gland

Dyspareunia Causes

Painful sexual intercourse may occur due to various factors, which may range from psychological problems to structural issues. The physical causative factors for the condition tends to differ, based on the timing of the pain or whether the aches originate with deep thrusting or at the time of entry of the penis.

Causes of Pain during Entry

Aches originating at the time of penetration may arise as a consequence of

Inadequate lubrication

This is frequently a result of inadequate foreplay before actual sex. It is also a result of a deficiency of estrogen levels following childbirth or at the time of breast-feeding or after menopause. It can also occur due to intake of some medicines (that include some birth control pills, high blood pressure medications, antihistamines, sedatives and antidepressants). Such drugs are known to reduce arousal or desire, which consequently diminish lubrication and make penetration painful.

Injury or irritation

Injury or irritation due to a congenital abnormality, female circumcision, accidents, pelvic surgery or episiotomy can also be a cause of this problem.

Infection, inflammation or skin problems

Painful intercourse can also occur due to an infection in the urinary tract or genital area. Aches may also arise due to eczema or other similar problems in the skin of the genital region.

Vaginismus

Vaginismus refers to uncontrollable spasms of the vaginal wall muscles which make penetration very difficult and painful for sufferers.

Causes of Pain during Deep Thrusting

Deep penetration usually gives rise to deep pain which may become more intense with certain positions. Such aches are usually a result of:

Medical treatments or surgeries

Pain during intercourse may arise due to scars from surgeries, such as Hysterectomy, that involves the pelvic region. Medical cure for cancer, such as chemotherapy and radiation, may also lead to changes that can cause pain during sexual intercourse.

Certain disorders

The presence of some conditions may also make sex a painful process for its sufferers. These include disorders like uterine prolapse, uterine fibroids, endometriosis, pelvic inflammatory disease, cystitis, irritable bowel syndrome, retroverted uterus, ovarian cysts and hemorrhoids.

Emotional Causes of Dyspareunia

The condition also arises due to some emotional factors associated with sexual activity. These include:

Stress

Stress in life often leads to a tightening of the muscles in the pelvic floor. This can be a contributory factor to pain experienced during intercourse.

Psychological problems

Psychotic conditions, such as depression, anxiety, relationship problems or fear of intimacy may lead to reduced arousal which may cause pain or discomfort as a consequence.

Past sexual abuse

Although a history of sexual abuse is not noticed in the majority of women with this disorder, past cases of sexual abuse might play a role in imagining pain during sex.

Dyspareunia and Menopause

The condition is most common in menopausal women and is said to arise in approximately half of all females after menopause. After menopause, the body of a woman produces less of the lubricating hormone known as estrogen. This results in thinning of the vaginal walls and vaginal dryness. This dryness of the vagina causes pain during intercourse, thus leading to Dyspareunia. The ability of the vagina to produce its own mucus deteriorates, thus causing itchiness, dryness and pain in the region during intercourse.

Dyspareunia Diagnosis

The diagnosis of this condition usually involves making a through pelvic examination. During examination, doctors can look for signs of skin infection or irritation. Presence of any anatomical problems may also be looked for. A doctor might also apply gentle pressure on the pelvic muscles and the genital region to determine the location of pain.

In some cases, physicians might use an apparatus (known as speculum) to isolate the vaginal walls and visually examine the vaginal passage. The process can be a little painful for some women and they should stop their doctors from carrying out the process any further at any time they feel uncomfortable.

The diagnosis also involves taking the medical history of patients into account. Doctors should also patients about their surgical and sexual history as well as their experiences during childbirth. Patients should also be asked about the time of origin of the pain, the location of discomfort and the sexual position of their own as well as of their partner. Patients are often embarrassed to give vivid details of their sexual positions. However, it must be remembered that it would not do any good to be embarrassed about giving clear answers regarding your sexual relationship. In fact, it might hamper the treatment.

Dyspareunia Differential Diagnosis

The differential diagnosis of Dyspareunia involves telling its symptoms apart from those of other similar disorders, like Vaginal Atrophy and Vulvar Vestibulitis Syndrome (VVS).

Dyspareunia Treatment

The treatment options for this disorder tend to vary. The cure for Dyspareunia depends on the underlying cause of the pain and discomfort experienced by sufferers. Medical treatment of the disease generally involves:

Medicines

There are no specific medications to cure this condition. Medicinal treatment may help cure any underlying condition, such as an infection, that might be the actual cause of this disorder. In some individuals, use of certain medications is known to cause problems in lubrication. Changing such drugs may also help eliminate such symptoms and cure the problem of painful intercourse.

In the majority of postmenopausal women, low estrogen levels result in inadequate lubrication which makes sex painful for them. This can be often cured with the aid of a tablet, prescription cream or flexible ring that releases estrogen directly to the vagina in very small quantities.

In some cases, drugs that relax pelvic muscles or increase blood flow are found to be effective in improving the condition.

Therapy

Various types of therapy, which are often found to be effective in curing this disorder, include:

Sex therapy or Counseling

If you have experienced pain during sex for a considerably long period, you may continue to exhibit a negative emotional reaction to sexual arousal even after cure. If you have avoided intimacy with your partner due to painful penetration, you should gradually restore your sexual relationship with him/her. Consult a sex therapist or counselor if you are unable to resolve such emotional problems by yourself.

Women with a history of sexual abuse or chronic Dyspareunia may require counseling to get rid of the discomforting symptoms of the condition.

Desensitization therapy

This therapy involves learning vaginal relaxation exercises which can help reduce pain in sufferers. Desensitization therapists recommend techniques like Kegel exercises or other types of pelvic floor exercises to reduce pain arising from intercourse.

Dyspareunia Home Remedies

The condition can also improve with the help of some natural measures, like:

Using lubricants

Water based lubricants can relieve dryness and discomfort and consequently, reduce risk of Dyspareunia from friction. However, you should avoid using oil-based lubricants like glycerin or Petroleum jelly which can promote yeast infection by dissolving the latex present in condoms. Read the labels before buying a lubricant over the counter. If you have doubts, you may ask your doctor to recommend a safe lubricant to you.

Using dilators

Inserting a graudated dilator set into the vagina can take care of problems arising due to Vaginismus.

Changing positions

If you feel your partner strikes your cervix too hard during copulation, you can try being on top of him to regulate intercourse to a depth that is comfortable for you.

Indulge in longer foreplay

Prolonged foreplay can help stimulate the estrogen in your body and can reduce pain by slowing down penetration until you are completely aroused.

Although the painful symptoms and other discomforting sensations cannot be resolved completely, you may at least minimize them by the aforementioned measures.

Dyspareunia Complications

The condition does not usually give rise to any major complications. In most cases, it affects the sex life of sufferers as well as their partners. The fact that many sufferers shy away from consulting a doctor prolongs the suffering for them.

Dyspareunia Prognosis

The condition has a good prognosis as its outcome after medical treatment is generally found to be successful. Although treatment can extend for several months, especially in case of victims of rape or other similar violent sexual trauma, affected individuals are generally found to enjoy their sex life after being cured. A majority of cases of this disease have their origins in a physical condition that can be treated with proper medical care.

If you are suffering from recurring pain during sex, contact a doctor as soon as you can. You might discuss the problem with your gynecologist or primary care provider during routine visits. You might be treated by your physician or referred to a specialist who can attend to the condition much better. When treated properly, Dyspareunia can be resolved quite swiftly thus allowing you to enjoy your sex life as you did before.