Dyspareunia

Dyspareunia (pronounced dis-puh-roo-nee-uh) is the clinical name for painful sexual intercourse. Many women feel pain in their vaginas when they first become sexually active. It takes time to settle into sexual maturity, not to mention physical acceptance of oneself, but it also takes practice to get to know how one’s body functions in response to certain stimulus, such as vaginal penetration. A woman eventually learns to recognize what types of touch feels good, as well as ways to avoid or eliminate discomfort experienced during sexual intercourse.

When pain takes over

But sometimes the pain just doesn’t go away and ends up wreaking havoc on a woman’s life, both in and out of the bedroom. For some, such “pain causes a woman to fear of lovemaking, which can cause her vaginal muscles to contract when they should be relaxing to cause an even more painful condition called Vaginismus”, notes practicing physician and radio talk show host Dr. Gabe Mirkin. Not only that, but the experience of seeing health professional after health professional in search of some explanation only adds to the frustration. Unfortunately, as the understanding of this area of medicine is still in its formative stages, this type of scenario occurs more often than is desirable.

Symptoms

Dyspareunia is defined as painful sexual intercourse, being “the persistent or recurrent pain with attempted or complete vaginal entry and/or penile Vaginal Intercourse”, according to the Association of Reproductive Health Professions (AHRP).

During (or soon after) intercourse pain may be felt deep inside the pelvis, inside the vagina, or at the opening of the vagina. The pain felt may be acute in nature or experienced as a dull, throbbing sensation; it can also present itself as a burning or irritating feeling on the skin.

Although Dyspareunia is prevalent among women, there is a rare form of it that also affects men. The feeling of pain in the genital region presents itself also as a sharp, stabbing, or burning sensation that occurs during (or right after) Ejaculation. As is the case with women sufferers, physiological and psychological causes are to blame.

Causes

Before examining psychological or emotional causes, medical practitioners must rule out whether a physiological one is to blame, as generally most instances originate from a physical basis. The AHRP’s list of the most common physical causes of Dyspareunia among middle-aged and older women is as follows:

• Atrophic vaginitis: This is the most common cause of sexual pain disorder among middle and older aged women, with an estimated ten to forty percent post-menopausal.
• Non-neoplastic epithelial disorders: Formerly known as vulvar dystrophy, this is a skin disorder that involves the vulvar skin thickening and (thus) causing chronic pain.
• Vestibulodynia (formerly known as Vulvar vestibulitis): Localized Vulvodynia (another classification of pain to the vulva that is unexplained by infection or skin disease) in the entry point into the vagina.
• A reduction in vaginal quality due to decreased estrogen or a lack of regular sexual intercourse (some discomfort is normally attributed to long periods of time without sexual activity)
• Other physical causes of Dyspareunia may also include:
• Sexually Transmitted Diseases/Infections (STDs/STIs), e.g. Chlamydia, Trichomoniasis
• other infections of the vagina, e.g. Bladder/Urinary Tract Infections bacterial or Yeast Infection
• Pelvic Congestion Syndrome
• Interstitial Cystitis
• Endometriosis
• Estrogen deficiency
• Vaginal Dryness

Once a physical cause has been ruled out, emotional or psychological causes need to be considered, such as: relationship problems; diminished blood flow to vagina due to lack of Foreplay; and/or, arousal sexual trauma.

Effects on Sexual Expression

Individuals suffering from Dyspareunia often feel frustration, as intercourse with their partner is painful. Despite the fact that sufferers enjoy sex and feel attracted to their lovers, they may begin to believe that they will never again be able to enjoy sex as they used to, or they resign themselves to believing that their symptoms are just a natural part of aging. Alternatively, it may worry some women to the degree that either: it affects their self-esteem (that they’re somehow ‘not good enough’); or, their condition affects the intimacy in their relationship; or, the lack of penetrative sex makes their partner feel hurt or rejected.

Controversy over DSM-IV Classification

There remains some question of the validity of Dyspareunia’s true place in the American Psychiatric Association’s diagnostics manual (the DSM-IV). A study by the University of McGill found that Dyspareunia’s current classification, “Fits the current DSM-IV-TR classification criteria for pain disorder better than it fits those for sexual dysfunction.” The call to re-categorize this condition is so significant because it has implications for the understanding and treatment of this common, though neglected, health problem.

Treatment

Fortunately, there are options for individuals suffering from Dyspareunia. If the pain condition was due to physical factors, follow your doctor’s instructions to treat the symptoms that are to blame. If emotional factors are at play, it’s vital that a sufferer and her sexual partner communicate about the conditions effects and ease into sexual activity patiently.

Depending on whether the pain is superficial or deep, there are a number of ways to work sex back into the equation when Dyspareunia has been in the picture:

• longer foreplay
• increased intimacy
• arousing a women sufficiently long enough so she can become lubricated; the use of personal Lubricant if vaginal dryness is still an issue
• exploring various Sexual Positions to find ones that are comfortable for her, e.g. poses that lengthen the vagina (woman’s legs outstretched) and positions that achieve differing contact points in the vagina during intercourse

Final Thoughts

Female sexual concerns like Dyspareunia are commonplace, affecting the lives of many women – and men. Increasing public awareness for such a condition can aid in furthering existing and future treatment strategies, and also provides encouragement for the many women who are too embarrassed to reach out for help. If you believe you suffer from this distressing condition, don’t let it go unchecked – talk to your doctor about it now and insist on receiving help to overcome it!