Painful Intercourse – Dyspareunia
What is dyspareunia?
Pain during or after intercourse is referred to as dyspareunia in medical terms. This refers to the pain and discomfort felt in the labia, vagina or deeper in the pelvis during sexual activity. Pain during sex can be superficial that is felt only at penetration (Superficial dyspareunia) or it can be deep and noticeable after penetration (Deep . There are numerous physical (illness, physical disorder), psychological and/or social factors that can be the cause of dyspareunia. Pain during intercourse must not be ignored as it is the body’s way of telling you that something is not right. Consultation with gynaecologist is essential for an accurate diagnosis.
What causes dyspareunia?
Dyspareunia at the time of penetration can be caused due to: (Superficial Dyspareunia)
1. Infection: Women may experience pain during intercourse due to an STI (Sexually Transmitted Infection) such as gonorrhoea, herpes, thrush, bacterial vaginosis, chlamydia, etc.
2. Vaginal Irritation – Women may also complain of dyspareunia due to irritation in the vagina that may be caused by spermicides, latex condoms, use of soap, shower gels or fragrances in the vagina.
3. Inadequate Arousal – Some drugs inhibit the desire for sex reduce the lubrication and thus result in painful sex. Antidepressants, antihistamines, birth control pills, and even blood pressure medicines can cause discomfort during intercourse.
4. Vaginismus – It refers to a medical disorder where the muscles in and/or around the vagina go into spasm (shut tightly) and thus lead to painful sex. At times, the pain is so severe that it intercourse becomes impossible.
5. Menopause: Women experience hormonal changes at the time of menopause. This can make the vagina dry and cause pain and discomfort during intercourse
Dyspareunia felt inside the pelvis can be caused by: (deep dyspareunia)
1. Endometriosis – Endometriosis is a condition where inner lining of the uterus (endometrium) grows elsewhere in the body, most often in the pelvis. Women with endometriosis may experience pain during periods and pain during intercourse.
2. Pelvic Adhesions – In some women, the tissues in the pelvis stick together most commonly due to a history of surgery or PID. If the uterus is involved in adhesions and is not mobile, women may complain about pain during intercourse.
3. Pelvic Inflammatory Disease (PID) – When there is infection of the female genitalia, which occurs when the sexually transmitted infection spreads higher up from the vagina into the uterus, fallopian tubes, and even the ovaries. This can lead to painful sexual intercourse.
4. Uterine Fibroids – Rarely fibroids can cause sexual intercourse painful and unpleasant when they are large and are present deep in the pelvis.
5. Constipation – Women complaining of constipation has faeces in her rectum and colon. Penetration during intercourse leads to pressure on the vagina which in turn pushes the rectum and this can lead to pain.
6. Emotional Factors – Some women may experience pain due to lower levels of arousal being attributed to anxiety, depression, insecurity or issues in their relationships. Thisleads to discomfort or pain during intercourse.
A good medical history and a thorough physical examination of the abdomen and pelvis usually leads to the diagnosis. Sometimes investigations may be needed depending on the cause behind, which include cervical swab and smear, vaginal swab, ultrasound scan, CT scan, or MRI of the pelvis.
Treatment course for dyspareunia is based on the reason behind. Antibiotics for infection, lubricants for dry sex, vaginal dilators for vaginismus, avoiding shower gels, flavoured soaps, fragrances, and latex condoms for irritation. Laparoscopy can be offered for diagnosis and treatment of endometriosis and finally psychosexual counselling for emotional factors.
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