Introduction

Dyspareunia, or painful intercourse, is a medical condition that affects individuals and their intimate relationships. However, it is often surrounded by misconceptions and shrouded in silence. It is one of the most sensitive and challenging topics to address. 

India has a 12.6% prevalence of dyspareunia, with greater rates in the central region among newly married and younger women, rural residents, and those who use traditional contraception. 

This blog is dedicated to shedding light on the hidden aspects of this condition, its causes, diagnosis, psychological impact, and treatments.

What is Dyspareunia?

Dyspareunia is the medical word for painful intercourse that may occur right before, during, or after sex.

Experiencing pain during sex is a challenge that many individuals face. It is important to acknowledge that this pain, whether it occurs just before, during, or after sex, is a valid concern that deserves attention and understanding.

Who is Most Likely to have Dyspareunia?

Many women, especially young ladies, are prone. Women after menopause may experience diminished vaginal suppleness, dryness, and constriction of the vaginal opening.

Women who undergo surgical menopause, which involves ovary removal for medical reasons.

Types of Dyspareunia

The location of the pain is a valuable clue that can help you better understand and identify the type of dyspareunia you may be experiencing.

Entry Pain or Superficial Dyspareunia:

During early penetration, some women experience pain near the vaginal entrance. Lack of lubrication, damage, or infection are all potential causes of discomfort during initiation.

Deep Pain or Collision Dyspareunia:

Particular sexual postures might exacerbate the pain of deep penetration. This discomfort will center in your lower abdomen or cervix. Experiencing more severe sexual pain is typically a result of a medical condition or previous surgery.

Experiencing pain during intercourse is a common concern that can be categorized as primary, secondary, complete, or situational.

Primary Pain refers to the experience of pain that has been there since the individual initiated sexual activity.

Secondary Pain arises after the experience of painless sexual activity.

Complete Pain refers to the experience of feeling pain consistently throughout sexual intercourse.

Situational Pain refers to the occurrence of pain exclusively during specific circumstances or postures.

Signs and Symptoms of Dyspareunia

The pain associated with dyspareunia might vary. It's possible to feel pain in:

• in the vagina, urethra, or bladder
• during penetration
• during or after intercourse deep in the pelvis
• after pain-free intercourse
• only with certain partners or circumstances
• with tampon use
• along with burning, itching, or aching
• with a feeling of stabbing pain, similar to menstrual cramps

Causes of Dyspareunia

Dyspareunia has several possible origins, both physiological and psychological.

Physiological Causes:

Inflammation or Infection: Conditions such as vulvar vestibulitis (inflammation of the vulvar opening), yeast infections, urinary tract infections (UTIs), and sexually transmitted infections (STIs) can result in soreness, dryness, and irritation, which can cause pain during sexual intercourse.

Vaginal Dryness: Lack of sufficient lubrication, a common issue during menopause or due to hormonal imbalances, can cause friction and discomfort during penetration.

Anatomical Variations: Specific medical diseases such as endometriosis, uterine fibroids, or pelvic adhesions can create physical obstructions or exert pressure on delicate tissues, leading to the experience of pain.

Pelvic Floor Dysfunction: Tightness or overactivity of the pelvic floor muscles can restrict vaginal opening and make penetration difficult, potentially causing pain.

Vulvodynia: This chronic pain condition affecting the vulva can occur even without contact but can be exacerbated during intercourse.

Genital Neuropathy: Nerve injury or damage affecting the nerves that provide sensation to the genital area can interfere with the normal transmission of pain signals, resulting in pain or heightened sensitivity.

Psychological Causes:

Fear of Pain: Having experienced pain during sex can lead to a heightened anticipation of future pain, producing a vicious cycle in which worry leads to muscular tension and discomfort.

Performance Anxiety: Worrying about your ability to please your partner during sex can cause stress and tense muscles, which can prevent relaxation and lubrication.

Adverse Attitudes towards Sex: Internalized negative or shame-based thoughts can affect arousal, relaxation, and enjoyment of sex, which can exacerbate anxiety and tension related to sex.

Body Image Problems: Feeling insecure about your appearance can make you less motivated to participate in sexual activities and less confident, which can exacerbate suffering.

Past Sexual Trauma: Physical reactions during sex, such as pain and tense muscles, might be a symptom of deep emotional scars left by sexual abuse or assault.

Depression: The presence of a depressed mood and reduced energy commonly associated with depression can harm both sexual desire and arousal, hence influencing one's overall sexual experience.

Stress: Chronic stress can cause muscle tension and make it hard to relax, which may result in pain during sexual activity.

Diagnosis of Dyspareunia

A medical evaluation for dyspareunia usually consists of:

A Medical History: Your doctor may ask you when the pain started, where it hurts, how it feels, and if it happens with all sexual partners and positions. Your provider may also ask about your sexual history, past surgeries, and births.

Pelvic Examination: A pelvic checkup lets your doctor see if there are any signs of skin irritation, infection, or problems with the structure of your pelvis. He or she might also try to find the source of your pain by putting light pressure on your pelvic and groin muscles. A visual check of your vagina may also be done.

Other Diagnostic Tests: If your doctor thinks there are certain reasons why intercourse hurts, he or she may also suggest a pelvic scan for better understanding.

Psychological Impact of Dyspareunia

Anxiety and Fear: Fear of pain during sex can cause anxiety and anticipatory stress, making it harder to relax and enjoy sexual connection. 

Relationship Problem: Dyspareunia can strain relationships and cause communication breakdowns between couples. Frustration, resentment, and withdrawal can accumulate, resulting in a decrease in closeness and emotional connection.

Body Image Problems: The pain associated with dyspareunia can make people feel bad about their bodies, particularly their genitals. This can result in feelings of shame, avoidance of intimacy, and difficulties expressing one's sexual needs and desires.

Sexual DIssatisfaction: Dyspareunia often takes away the joy and pleasure of sexual intimacy. Individuals may struggle with arousal, difficulty reaching orgasm, and a general sense of frustration and dissatisfaction with their sex life.

Genophobia: In severe circumstances, fear of pain can develop into a dread of sex (genophobia). This can have a substantial impact on a person's entire sexual health and well-being.

Treatments for Dyspareunia

The goal of treatment is to alleviate whatever is triggering the disease. 

It is possible to lessen the discomfort of sexual activity by:

• using lubricants that dissolve in water
• prolonging foreplay to stimulate the release of endogenous lubricants
• reduced intense discomfort through improved partner communication and the selection of comfortable sexual positions

Medications

• Medication can alleviate discomfort caused by illness or injury.
• A physician may suggest switching to a different drug if the one they are currently on is causing vaginal dryness
• If low estrogen levels are the cause of vaginal dryness, topical estrogen may be helpful. Consult with your physician before taking any medications

Counselling

• Relationship issues may emerge after a painful encounter. A relationship counselor could be helpful in this situation
• Counseling may be helpful for dyspareunia if sexual assault, trauma, or other emotional disorders are to blame

Healthful Sexual Habits

• Changes in behavior and perspective can alleviate conflict in relationships
• Alterations in sexual habits

Taking Care of One's Reproductive System

• Practicing proper genital hygiene, safe sex, and regular medical check-ups will assist in preventing genital and urinary infections that can lead to painful intercourse

Performing Kegel Exercises

• Kegel exercises have been shown to help strengthen the pelvic floor muscles of some women who suffer from vaginismus.

How to Avoid Dyspareunia?

Possible causes determine how to prevent painful sex. Some causes of painful sex can be prevented by:

• Increase foreplay for natural lubrication.
• Postmenopausal women should use estrogens when suitable.
• Olive oil or water-based lubricants
• STIs can induce dyspareunia, therefore, practice safe sex.

Broaden Your Views

You may need to change your habits as you mature. You may require more time or other approaches to arouse or orgasm, so involve your partner.

Treatment methods rarely work immediately, so you may not see visible changes. Focus on different ways to meet your and your partner's needs.

Love and intimacy can be shown without touching. Kissing, hugging, massage, mutual masturbation, and oral sex can broaden your sex life definition.

Seek Professional Help

Consult your doctor immediately if you are having painful sex. Your doctor may suggest a psychologist or sex therapist. Early help might also reduce relationship damage.

FAQs

What is the difference between dyspareunia and vaginism?

Dyspareunia is persistent pain during or after sex, caused by factors like infections or psychological issues. Vaginismus involves pelvic floor spasms, making penetration painful or impossible due to fear, trauma, or anxiety.

How is dyspareunia treated?

Treatment may involve therapy for psychological issues, medication for infections or dryness, and lifestyle changes. Physical treatment or surgery may be recommended. A combination of approaches is often used based on the specific cause.

Is dyspareunia harmful?

While not life-threatening, dyspareunia can have physical and emotional impacts on relationships. Seeking medical guidance is crucial to addressing underlying issues, ensuring proper treatment, and enhancing overall well-being and intimacy.

What causes cramps after sex?

Muscle strains, urinary difficulties, sexually transmitted infections, and other conditions can produce these symptoms.

Conclusion

Dyspareunia is a challenging condition that can impact your physical and emotional well-being, but it can be treated with the right approach.

Seeking professional help is a powerful step towards receiving an accurate diagnosis and personalized treatment.

By adopting a holistic approach that encompasses both the physical and psychological aspects, individuals facing dyspareunia can discover relief and reclaim a satisfying and empowering sexual life.

The support of healthcare providers, counselors, and partners is priceless when it comes to managing and triumphing over this condition.

References

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2. Jean Hailes for Women’s Health, Painful Sex. Available at https://www.jeanhailes.org.au/health-a-z/sex-sexual-health/painful-sex-dyspareunia. (Accessed 16, November 2023)
3. Cleveland Clinic, Dyspareunia (Painful Intercourse): Causes, Diagnosis & Treatment. Available athttps://my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse. (Accessed 16, November 2023)
4. Medical News Today, What causes dyspareunia, or painful intercourse? Available at https://www.medicalnewstoday.com/articles/192590. (Accessed on 16, November 2023)
   
5. Healthline, What You Need to Know About Dyspareunia (Painful Intercourse). Available at https://www.healthline.com/health/dyspareunia. (Accessed on 16, November 2023)
6. Mayoclinic, Painful intercourse (dyspareunia) - Symptoms and Causes. Available at https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967. (Accessed on 16, November 2023)