Dyspareunia
Quick Reference
Reviewed by Jonathan Smith, MD
Dyspareunia is the umbrella term for painful sexual intercourse in women. The causes of dyspareunia vary widely, and include, but are not limited to, infection, an abnormally positioned uterus, muscle spasms in the vagina, preexisting disorders of the reproductive system, and emotional distress from prior sexual trauma or abuse. The pain, depending on its cause, can range from mild to intense, and women who suffer from dyspareunia regularly can find it very distressing, because of both the physical discomfort and the impact on their intimate lives.
Detailed Description
Dyspareunia may arise from a broad range of underlying problems. If dyspareunia involves the vaginal tissue and entrance of the vagina, it could be cause by vaginal dryness due to lack of arousal, side effects of medication (allergy, high blood pressure, anti-depressant medications are most often to blame), or menopause and the friction of intercourse. Other common causes of this type of dyspareunia include allergic reactions to laundry detergents, soaps, or other topical products such as spermicides. Bacterial or fungal infections that irritate vaginal tissue can also be to blame, as can STDs such as herpes and genital warts. Another potential cause of this type of dyspareunia can be a condition called vulvodynia, in which the vulva are tender and hypersensitive to touch. Dyspareunia that involves pain inside the vagina or abdominal pain during can be connected to a similarly wide range of causes. One common culprit is a tipped or retroverted (backwards) uterus; often, penile thrusting can come into painful contact with the uterus or cervix if the uterus is abnormally positioned. Another possible cause is an inflamed or irritated bladder or urinary tract due to urinary tract infection (UTI). A condition called endometriosis, where the tissue lining of the uterus begins to grow in locations outside of the uterus, can cause intense pain during sex, as can accumulations of scar tissue from prior pregnancy or abdominal surgery. Some women suffer from a condition called pelvic floor myalgia, or involuntary muscle spasms of the pelvic floor, which can make sexual intercourse painful or downright impossible. Ovarian cysts, uterine fibroids, and uterine or ovarian cancer may also be to blame. If none of these problems or conditions is found to be the cause, it may be that emotional components, such as anxiety, prior sexual abuse, or prior sexual trauma, play a role in dyspareunia, causing any of a number of uncomfortable or painful symptoms, such as lack of lubrication, muscle tensing, or painful sensitivity to contact or penetration.
Treatment
The treatment for dyspareunia depends very much on the underlying cause, and can include anything from a simple change of soap to surgery. Problems with vaginal lubrication can be helped by the use of personal lubricants, hormone therapy for menopausal women, or simply by increasing arousal. UTIs, infections of the reproductive tract, and infections of the surrounding tissue can usually be treated fairly easily, with a course of antibiotics, or antifungal medications. Recurrence of such infections can be prevented by having protected sex to reduce the change of STD infection, and keeping the vaginal area clean and free of irritating chemicals or synthetic materials that can increase the change of microorganism growth. Severe cases of endometriosis may require surgery, as can a tipped or retroverted uterus, but discomfort can often be decreased by avoiding deep penetration or experimenting with different positions during intercourse. Overgrowth of scar tissue can be dangerous, and may require surgery to prevent other, more severe medical conditions. Life-threatening conditions such as cancer of the reproductive tract require immediate, intensive treatment, even if there is no dyspareunia involved. If no physiological cause can be found, and dyspareunia seems to have an emotional root, counseling may be necessary to reduce or eliminate symptoms, especially if the patient has avoided seeking treatment for a long period of time, which can increase the surrounding anxiety as patients begin to associate all sex with pain and discomfort. Because there are so many potential causes of dyspareunia, it is important to report any pain during sexual intercourse to a medical care provider, who can check for potentially dangerous underlying disorders and suggest the best treatment or preventative measures.
Last updated: 27-Oct-03
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