What is Dyspareunia?


A woman experiencing discomfort on a sofa


Dyspareunia describes persistent or recurrent pain in the genital area or within the pelvis that worsens during sexual intercourse. The pain is often described as sharp or intense, and it can occur before, during, or after sexual intercourse. Causes vary widely, and numerous factors can contribute, which can lead to distress and relationship problems.

What is Dyspareunia Symptoms

One of the most distinguished dyspareunia symptoms is pain with intercourse at the vaginal opening or deep in the pelvis. The most common sensations people feel are aching, throbbing, or ripping. It can result in dissatisfaction or disinterest in intercourse.

What Causes Dyspareunia

The causes are varied and can include physical or psychological factors, sometimes both. The pain is distinct and localized for some people, but others feel a broader sense of discomfort. Locating the pain is vital and helps identify a specific physical cause.

There are two types of dyspareunia, classified as entry and deep. Entry dyspareunia refers to pain experienced with initial or attempted penetration of the vagina. Deep dyspareunia refers to pain felt during deep vaginal penetration. The cause of dyspareunia differs depending on whether the pain is entry or deep.

What is Deep Dyspareunia 

If you feel pain when deep penetration occurs or if it is more acute in a particular position, it can be a result from a medical condition, which can lead to pain, or may require pelvic surgery. Causes include:

  • Cystitis:  An inflammation of the bladder wall, usually caused by bacterial infection.
  • Endometriosis:  A condition arising from the presence of tissue from the uterus in other areas of the body.
  • Fibroids:  Non-cancerous tumors that grow on the wall of the uterus.
  • Interstitial cystitis:  A chronic painful bladder condition.
  • Irritable bowel syndrome (IBS):  A functional disorder of the digestive tract.
  • Ovarian cysts:  A build-up of fluid within an ovary.
  • Pelvic inflammatory disease (PID):  A functional disorder of the digestive tract.
  • Uterine prolapse:  One or more pelvic organs extend into the vagina.

What is Superficial Dyspareunia 

Entry dyspareunia occurs with penetration and can be caused by a range of factors, including:

  • Vaginal dryness:  During arousal, glands at the entrance of the vagina secrete fluids to aid penetration. Not enough lubrication can make sex painful. This results from lack of foreplay, reduction in estrogen (particularly after menopause or childbirth), medication such as antidepressants, or birth control.
  • Injury, trauma, or irritation:  Any trauma to the genital region can lead to dyspareunia. This includes any type of accident, pelvic surgery, childbirth, episiotomy, hysterectomy even genital mutilation. 
  • Inflammation or infection:  Infections such as yeast, urinary tract infections (UTIs), or sexually transmitted infections (STIs) can also cause painful intercourse. Even skin disorders in your genital area like eczema, lichen planus, lichen sclerosis, and other skin problems can cause discomfort.
  • Congenital abnormality:  A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could cause dyspareunia.
  • Vaginismus:  There are several forms of vaginismus, and symptoms vary from person to person. The involuntary contraction of the pelvic floor muscles can cause vaginismus which leads to painful intercourse. 

Psychological Causes

Some psychological factors can also play a role in painful intercourse. Anxiety, fear, and depression can inhibit sexual arousal and contribute to vaginal dryness. Moreover, stress can trigger a tightening of the pelvic floor muscles, resulting in pain.

Another factor that contributes to dyspareunia is a history of sexual abuse or sexual violence.

What Does Dyspareunia Feel Like 

Some people who suffer from dyspareunia have described the pain as menstrual cramps, while others report a sharp, burning sensation. People with vaginas often say they feel as if something is being bumped deep inside the pelvis.

What is Dyspareunia Due to Menopause 

The hormonal changes that come with menopause are one of the leading causes of dyspareunia. The significant decrease in the production of estrogen results in less optimal genital blood flow, changes in vaginal tissue, and vaginal epithelium becoming thin.

How Common is Dyspareunia 

Dyspareunia is one of the most common problems of postmenopausal people with vaginas. These patients report a history of vaginal dryness, decreased vaginal lubrication during sexual activities, decreased arousal, orgasm, or sexual desire. More details can be found through a physical examination.

Medical evaluations for dyspareunia usually consist of a thorough medical history. Your doctor might ask when your pain began, where it hurts, how it feels, and if it happens with every sexual partner and every sexual position. Although some people might feel embarrassed, there is nothing to be shy about. Answering the questions truthfully can provide better clues to the cause of your pain. 

A doctor will perform a pelvic exam to check for any signs of skin irritation, infection, or anatomical problems. Then, with an instrument called a speculum, they will perform a visual exam of your vagina. This is inserted into the vagina to enable a visual examination which can be painful for some people who experience pain during intercourse. 

Telling the doctor when and where the pain occurs during the examination may help identify the cause, and if it is too painful to handle, you can ask to stop the exam.

How Long Does Dyspareunia Last 

Once your doctor detects the root of your pain, they will suggest a treatment to ease the symptoms. It is important to remember that there are several options to deal with dyspareunia. The more constant you are with your treatment, the faster the symptoms will disappear.

Can Dyspareunia be Cured 

Dyspareunia can be managed medically with prescription and nonprescription therapies. Topical estrogen, vaginal lubricants, and moisturizers are viable treatment options. There are also natural ways to help ease the symptoms of dyspareunia, well worth exploring.

Furthermore, counseling should be the top priority treatment for people who have suffered from sexual abuse, trauma, or other emotional issues. Even if you do not have a psychological cause, it is good to attend counseling to cope with the emotional consequences of painful or difficult intercourse.

Changing your lifestyle and sexual behavior can help reduce pain during sexual activities as well. Engaging longer in foreplay to encourage secretion of the natural lubrication produced by the body, good communication between you and your partner, choosing a comfortable sexual position to minimize deep pain, and using water-based intimate skincare products to help with the lack of wetness you may experience are some ways to achieve this.

Using lubricants is effective way to ease the discomfort caused by vaginal dryness, as they moisturize and add glide to the skin.

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