What is dyspareunia and its treatment?

Dyspareunia refers to recurrent discomfort in the vaginal region or the pelvis, during sexual intercourse. Although men can be affected by this condition, women are more likely to be affected. Dyspareunia causes discomfort in the vaginal canal, clitoris, and labia in women. The pain might be mild or severe. It can happen before, during, or after sexual intercourse. Women may feel discomfort at the entrance to the vaginal canal or deeper during entry or thrusting of the penis. During penetration, the vaginal muscles may tense spasmodically (vaginismus). This may have a significant psychosocial impact on a woman, which can have ramifications for the entire family, since women are the foundation of strength in every family.

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Prevalence of Dyspareunia

Because many women never seek medical treatment, no one knows how widespread it is. However, according to surveys asking women if they have symptoms, between 1 and 4 out of 10 women affected by dyspareunia. The majority of the time, this occurs early in their sexual lives or around menopause. 75% of all women have had an unpleasant sex encounter at some time in their lives. The problem is usually only temporary for most women and does not necessitate seeing a doctor.

Dyspareunia is believed to affect 3 to 18% of the global population, with lifetime estimates ranging from 10 to 28%. 7.5% of sexually active women reported painful sex, with one-quarter reporting symptoms very often or constantly for less than six months and causing discomfort. Other sexual function issues, such as vaginal dryness, sex anxiety, and a lack of satisfaction in sex, were highly linked to reporting painful sex.

In India, around 12.6% of women had dyspareunia, with rates greater in the central area, among recently married and younger women, rural residents, and nonusers or traditional contraceptive method users.

Symptoms of Dyspareunia

Dyspareunia pain can be severe or mild, and it can vary. Pain may occur:

  •  in the vaginal, urethral, or bladder 

  • during penetration during or after intercourse deep in the pelvis during or after intercourse 

  • after pain-free intercourse 

  • only with specific partners or circumstances 

  • with tampon use

  • along with burning, itching, or aching with a stabbing pain, similar to menstrual cramps.

Women frequently report the sensation as if something is pressing against them inside. During penetration, some women may suffer significant tightness of the vaginal muscles, a condition known as vaginismus.

Assessment of Dyspareunia

Superficial Dyspareunia (entry point pain)

Pain in the vaginal lips (labia), the vaginal entrance (introitus), and the bottom region of the vagina are all symptoms of this condition. It usually starts with penetration or shortly after the start of intercourse. It's a throbbing pain that happens all of a sudden. Stopping penetration typically relieves discomfort immediately, but it may be painful to the touch for a few minutes later. Pain during penetration might be associated with a range of factors, including not enough lubrication; injury, trauma or irritation; inflammation, infection or skin disorder; vaginismus; or congenital abnormality.

Deep Dyspareunia (deep pain)

This is a term used to describe pain in the pelvis that occurs during or after intercourse. It may even spread to the fronts of the thighs. It might be acute or mild, the pain may end when the penetration stops, or it can last minutes or even hours. The causes of this sort of discomfort are generally found deeper inside the pelvis.

With deep penetration, severe pain is generally experienced. In some positions, it may be even worse. Endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor dysfunction, adenomyosis, haemorrhoids, and ovarian cysts are just a few of the illnesses and conditions that can cause deep pain.

Causes of Dyspareunia

A number of factors can contribute to dyspareunia. It can be an indicator of a physical condition for some women. Other women may be in pain as a result of psychological or emotional issues. The following are some of the most common physical causes of dyspareunia:

  • Menopause, childbirth, breastfeeding, medications, or too little arousal before intercourse can cause vaginal dryness leading to pain.

  • Ulcers, cracking, itching, and burning as symptoms of skin problems.

  • Infection, such as yeast or urinary tract infections (UTIs) 

  • Injury, scarring or trauma from childbirth, an accident, an episiotomy, a hysterectomy, or pelvic surgery 

  • Vulvodynia, or pain centred in the vulva area vaginitis, or vaginal inflammation

  • Vaginismus, or a spontaneous tightening of the vaginal wall muscles

  • Endometriosis

  • cystitis

  • pelvic inflammatory disease (PID)

  • Abnormalities inside the uterus. Fibroid development, if the uterus is tilted, or if the uterus prolapses (falling) into the vagina are all possibilities.

  • irritable bowel syndrome (IBS)

  • radiation and chemotherapy

  • A diaphragm or cervical cap that isn't properly fitted. These are birth control methods.

  • Muscle spasms in the vaginal area. For some women, the spasms are so painful that sexual activity is impossible.

  • Congenital (from birth) or structural abnormalities such as vaginal septation (a bridge separating the vagina) or Pelvic organ prolapse (bulging or descent of organs)

Dyspareunia can be caused by factors that diminish sexual desire or impact a person's ability to become aroused. These factors include:

  • Concerns about sex self-image or physical concerns can lead to feelings of anxiety, remorse, or humiliation.

  • Birth control pills 

  • Relationship issues

  • Cancer, arthritis, diabetes, and thyroid illness

Emotional Factors:

Because emotions are so closely linked to sexual activity, they might have a role in sexual pain. 

  • Psychological issues: Low arousal and accompanying discomfort or suffering might be caused by anxiety, sadness, concerns about your physical attractiveness, fear of intimacy, or relationship issues.

  • Stress: When you're under a lot of stress, your pelvic floor muscles tend to tighten. This might cause discomfort during intercourse.

  • History of sexual abuse: Although not everyone with dyspareunia has a history of sexual abuse, it might play a role if an individual has been abused.

Treatment of Dyspareunia

Treatment options are determined on the source of your pain. Sexual lubricants (over-the-counter medications), medicines for infections, a different form of birth control, or surgery are some of the options.

  1. Medications

The doctor may prescribe the following to relieve your pain if it is caused by an underlying illness or disease:

  • Antibiotics

  • Antifungal prescriptions

  • Corticosteroids, topical or injectable

The doctor may modify a prescription if a long-term drug is causing vaginal dryness. Alternative medicines may help to restore natural lubrication and relieve pain.

Dyspareunia is a condition caused by low oestrogen levels in certain women. A small, regular dosage of estrogen can be administered to the vaginal area through a prescription pill, cream, or flexible ring. On vaginal tissues, the estrogen-free medication ospemifene (Osphena) works like estrogen. It works by thickening and strengthening the tissues. This may lessen the amount of discomfort women feel during sexual activity. The drug's disadvantages include the possibility of hot flashes, as well as the danger of stroke, blood clots, and uterine cancer (endometrium).

Dyspareunia is caused by insufficient lubrication produced by decreased oestrogen levels in many postmenopausal women. This is frequently treated with topical oestrogen administered to the vaginal area. 

  1. Other treatments

Certain non-pharmaceutical treatments may also treat with dyspareunia:

  • Desensitization therapy. You learn pain-relieving vaginal relaxation methods.

  • Counseling or sex therapy. Even after treatment, if sex has been painful for a while, you may retain a negative emotional response to sexual stimulation. If you and your partner have avoided intimacy as a result of painful intercourse, you may want assistance in enhancing communication and reestablishing sexual connection. These difficulties can be resolved by speaking with a counsellor or sex therapist. Changes in negative thinking patterns and behaviours might also be beneficial from cognitive behavioural therapy.

  • Home care: These home treatments for dyspareunia might also help with the symptoms:

-Use lubricants that are water soluble.

-Have sex when you and your lover are both calm.

-Discuss your pain with your spouse in an open and honest manner.

-Before intercourse, empty your bladder.

-Before intercourse, take a warm bath.

-Before intercourse, take an over-the-counter pain medication.

-To relieve burning after intercourse, use an ice pack to the vulva.

Until the underlying problems are treated, alternatives to sexual intercourse may be beneficial. Other intimacy techniques might be used by you and your partner until penetration is more comfortable. Dyspareunia symptoms are unpleasant and depressing. They have the ability to affect your sex life, fertility, and even your relationship. Many of the causes have simple solutions, and it is critical to get help if you are experiencing problems.


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