Dyspareunia or Painful Intercourse

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.

Dyspareunia: Understanding Painful Intercourse

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% rate of dyspareunia. This condition is more common in the central region. It affects newly married and younger women more.

Rural residents and those using traditional contraception also have higher rates. 

This blog aims to reveal the hidden parts of this condition. It covers causes, diagnosis, psychological effects, and treatments.

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 an important clue. It can help you understand and identify the type of dyspareunia you may have.

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: Certain 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.

Many people experience pain during intercourse, and they can categorize it as primary, secondary, complete, or situational.

Primary pain refers to the experience of pain that has been there since the individual's initiation of sexual activity.

Secondary pain arises subsequent to 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 specific postures.

Signs and Symptoms of Dyspareunia

​The pain associated with dyspareunia might vary. It's possible to feel pain 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 can cause pain during sex. Conditions like vulvar vestibulitis, yeast infections, urinary tract infections (UTIs), and sexually transmitted infections (STIs) can lead to soreness, dryness, and irritation.
• 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: Certain medical conditions like endometriosis, uterine fibroids, or pelvic adhesions can block or press on sensitive tissues. This can cause 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 have an adverse effect on 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.

Treatments for Dyspareunia

​It is the goal of treatment to alleviate whatever is triggering the disease. Medication and therapy are also viable options.

1. 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.

Women with dyspareunia who have ruled out psychological causes may benefit from counseling to help them deal with the psychological fallout of having to endure painful or difficult sexual activity.

2. Medication

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

3. Healthful Habits and Natural Cures

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

​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

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.

Perform Kegel Exercises

• Kegel exercises have been shown to help strengthen the pelvic floor muscles of some women who suffer from vaginismus.
• Try to pause your urinating in midstream to identify these muscles. Successful urination indicates that the target muscles have been located.
• Contract and hold, then release these muscles for 10 seconds. Do thrice daily for a total of ten repetitions.
• While doing Kegel exercises, it can be beneficial to focus on deep breathing.
  

​

Psychological Impact of Dyspareunia

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 have an adverse effect on 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.

How to Avoid Dyspareunia?

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

1. Increase foreplay for natural lubrication.
2. Postmenopausal women should use estrogens when suitable.
3. Olive oil or water-based lubricants
4. 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.

Seeking Aid

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.

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.

FAQs

What Is The Difference Between Dyspareunia And Vaginismus?

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.

Is Dyspareunia Harmful?

Dyspareunia, or painful intercourse, can have physical and emotional effects, impacting relationships. While not life-threatening, it requires attention as it can indicate underlying issues. Seeking medical guidance helps address causes and ensure proper treatment, enhancing overall well-being and intimacy.

What Is The First-Line Treatment For Dyspareunia?

Treatment for dyspareunia depends on its cause; options include lubricants, counseling, pelvic floor therapy, hormone therapy, or surgical interventions.

References

• ​Padmadas SS, Stones RW, and Matthews Z. Dyspareunia and urinary sensory symptoms in India: Population-based study. J Sex Med 2006;3:114–120 (Accessed at 16, November 2023)
• 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)
• Cleveland Clinic, Dyspareunia (Painful Intercourse): Causes, Diagnosis & Treatment. Available at https://my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse. (Accessed 16, November 2023)
• Medical News Today, What causes dyspareunia, or painful intercourse? Available at https://www.medicalnewstoday.com/articles/192590. (Accessed on 16, November 2023)
• Dyspareunia. Available at https://en.wikipedia.org/wiki/Dyspareunia. (Accessed on 16, November 2023)
• Healthline, What You Need to Know About Dyspareunia (Painful Intercourse). Available at https://www.healthline.com/health/dyspareunia. (Accessed on 16, November 2023)
• 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)