Men and women of all ages experience sexual problems. For older persons the aging process contributes to the cause of sexual problems, Research has indicated that 43% of women and 31% of men reported having sexual dysfunction to different degrees. At the same time not many persons are comfortable discussing their sexual issues with their healthcare providers. The good news is there are many medical and surgical solutions to relieve the pain and suffering caused by common sexual complains such as sexual pain, low libido (sexual drive), and impotence. The focus of this article is on painful intercourse and the conditions which result in many women suffering (at times) in silence. It is time to break the silence.
Persistent or recurrent painful sexual intercourse is called dyspareunia. There is usually either a medical issue or a psychological cause. Dyspareunia is far more common in women than men and can occur during or after sexual intercourse. The pain can be experience in the vagina, clitoris, labia or deeper in the pelvis when there pressure is placed on the cervix. Dyspareunia can cause problems in relationships and ruin sexual intimacy. Once the underlying problem is diagnosed and treated, painful intercourse can be alleviated.
The diagnosis requires the following:
- A detailed medical interview on the painful intercourse including:
- When is the pain experienced (during or after sex)
- Where hurts (the introitus, vault or deep in the vagina), pelvic area
- Which position worsens or alleviates the pain
- Other symptoms (post coital bleeding, urinary symptoms, vaginal discharge etc.)
- A complete gynecological examination entails visual external inspection, internal inspection with a speculum and good lighting, abdominal palpation, a digital exam. If the physical exam causes unbearable pain the doctor may then just opt to skip to the diagnostic tests
- Diagnostic tests
- Pelvic ultrasound
- Vaginal ultrasound
- High vaginal swab for culture and sensitivity tests
- Pap smear
- Vaginal Dryness
Typically a woman experiences vaginal dryness as she ages. Insufficient lubrication results in pain with potential bleeding during the sexual act. For younger women the vagina is naturally lubricated by the body as a defense against infection and injury. Once an individual is sexually aroused there is extra production of lubrication to facilitate the act of coitus and minimize bruising. Water soluble lubricants are sold over the counter to alleviate dryness. Vaginal topical hormone creams are also prescribed by the doctor
Birth defects of the genitalia can result in deformities of the vulva and vagina. Traumatic injuries to the pelvic area can also result in scarring and deformities of the sex organs. Pelvic organ surgeries can contribute to scarring and adhesions.
The moisture and warmth in the vaginal vault can promote the overgrowth of bacteria or fungus (yeast infections are fairly common). The infection caused by bacterial overgrowth, candida and other organisms can result in inflammation of the vaginal mucosa. Sexual intercourse can be very painful if attempted.
Endometriosis is a chronic, painful condition that has no cure. The cells of the tissue that line the uterus are called endothelial cells. These cells can migrate to other parts of the body, grow into clumps of tissue and respond to the same hormonal cyclical changes as the uterus. If fact where ever these abnormal tissues are there is bleeding during the menses. It is still not clearly understood why endometrial tissue grows outside of the uterus. High estrogen levels worsen the symptoms and this explains why this gynecological problem is seen in the adolescent years up to women in their 40s. Symptoms improve and may even abate in the menopausal period of a woman’s life.
These are benign tumors which can occur in or on the outside of the walls of the uterus. These non-cancerous growths vary in sizes from a couple centimeters to the size of a 5 months pregnancy. Undue pressure on the pelvic area or deep thrusting during coitus can result in pain.
- Ovarian cyst
Cyst on the ovary can reach massive sizes and result in undue pressure on pelvic organs which is painful. Pelvic pain makes sexual intercourse painful.
- Pelvic Congestion Syndrome
Chronic infection and inflammation of the pelvic organ can result in distressing pelvic pain. Sexual intercourse is practically impossible during acute on chronic episodes.
Menopause signals an end to the reproductive phase of a woman’s life. The hormones which control fertility also keeps the vaginal lubricated. With menopause comes the drastic decrease in these hormones. Vaginal dryness and decreased libido can make sexual intercourse painful and not at all pleasurable.
- Dyspareunia episiotomy
The surgical incision made to facilitate child birth is called an episiotomy. The resulting scars can deform the vaginal vault making coitus painful. Traumatic tears of the vagina during delivery if not carefully sutured can healed leaving a scarred, deformed vagina
- Dysuria dyspareunia
Urinary infections can affect the urinary tract including the bladder and urethra. The resulting burning and frequency of urination interferes with sexual intercourse making it painful.
- Pelvic pain dyspareunia
Any condition which causes pelvic pain will naturally hinder sexual intercourse which puts pressure on the pelvic organs
- Incontinence dyspareunia
A common cause of urinary incontinence is a prolapse of the urethra. Sexual intercourse is painful and can exacerbate the condition.
Stress, performance anxiety, relationship discord, guilty feelings and past traumatic experiences are some of the psychological causes of sexual dysfunction and dyspareunia.
Vaginismus is the involuntary contraction of the vaginal muscles usually triggered by fear or anxiety. When this spasm occurs, penetration during sexual intercourse is impossible and it can also make it difficult for the doctor to perform gynecological examinations. Vaginismus is sometimes associated with post-traumatic stress disorder.
Treatment of Vaginismus
- Talk therapy
- Vaginal trainers
- Pelvic floor exercises
Surgical interventions to correct dyspareunia
In some cases it may become necessary to perform surgery to enlarge the vagina. Reconstruction of deformed labia, vulva or vaginal vault is done by plastic surgeons. Labiaplasty is the term used to reconstruct the labia (the lips) and vaginoplasty refers to plastic surgery to improve the vagina. Minor surgeries are done to remove the adhesions caused by scar tissue which result from previous surgeries and injuries.
Tips to resolve painful sex
- Vaginal lubricant
- Treatment of the infection
- Surgically removing fibroids and cysts
- Estrogen therapy (treatment with hormones)
- Exploring different coital positions
- Couple’s therapy with a sexologist
A word on Dyspareunia in Men
Even though dyspareunia is not common in men some have experienced pain in the testicles or penis in the area of the glans after ejaculation. Prostatitis, urethritis, sexually transmitted infections, painful retraction due to the foreskin being too tight (Peyronie’s disease), tension in a short and slender frenulum also called Frenulum breve.
These conditions should not be ignored as they can be resolved with antibiotics in the case of an infection and minor surgery with respect to Peyronie’s disease and Frenulum breve.
Dyspareunia whether in men or women can be significantly resolved. It is important to share with your partner what you are experiencing. Take the next step by making an appointment to see your doctor who will diagnose the cause and give options to having the underlying problem resolved.
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