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Dyspareunia
(Painful Sexual Intercourse)

Definition:
Dyspareunia refers to pain in the pelvic area during or after sexual intercourse. This can occur in both men and women, although it is more common in women.

Causes:

women
It is believed that dyspareunia is caused by organic (physiological) factors at least 75%-80% of the time.

Pain that occurs initially at entry but decreases over time is commonly caused by inadequate lubrication. This is frequently due to a lack of sexual arousal and effective stimulation, and may sometimes be due to medication that decreases vaginal lubrication (such as antihistamines).

Other causes in women include:

  • Postpartum period after childbirth
  • Vaginal infections (eg, yeast vaginitis)
  • Postmenopausal atrophic vaginitis (irritation of the vaginal mucosa due to lack of estrogen)
  • Endometriosis
  • Herpes or genital warts
  • Pelvic inflammatory disease (deep infection of the pelvic organs)
  • Urinary tract infection
  • Orthopedic problems affecting the pelvic bones
  • Retroversion (abnormal orientation) of the uterus
  • Chronic constipation

Psychological factors are infrequently involved and will most commonly be associated with previous sexual trauma (rape or abuse), feelings of guilt, or negative attitudes toward sex. These psychological factors may lead to a condition called vaginismus, which are painful rhythmic contractions of vaginal muscles associated with dyspareunia.

Men
In men prostatitis and urethritis are the most common causes of pain that occur at the time of ejaculation. Pain that occurs while obtaining an erection may be associated with:
  • Inflammation of the foreskin
  • Loss of elasticity of the foreskin
  • Trauma to the penis
  • Herpes or genital warts
  • Local allergies or irritations
  • Curvature of the penis caused by Peyronie's disease
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Postmenopausal women and those taking medications that produce a vaginal dryness are at increased risk for dyspareunia.

Symptoms:
Pain associated with dyspareunia may:
  • Occur during or after sex
  • Be itching, burning, stabbing, or aching
  • Be located in the:
    • Vagina
    • Urethra
    • Bladder
    • Pelvis
    • Penis
    • Testicles
  • Occur during all phases of sexual contact or only with deep thrusting
  • Also occur with tampon use

Diagnosis:
The diagnosis of dyspareunia is typically made based on your symptoms. Your medical and sexual history and your physical examination will help your doctor determine the cause of your symptoms.

  • During the physical examination, your doctor will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), genital warts, or scarring.
  • Your doctor will also perform an internal pelvic examination, looking for abnormal pelvic masses, tenderness, or signs of endometriosis.
  • Based on the results of the history and physical examination, your doctor may recommend further testing such as cultures to detect infections or imaging studies (eg, pelvic ultrasound) to further investigate possible causes.
  • He or she may also suggest that you speak with a counselor to determine whether a history of sexual abuse, trauma, or anxiety may be contributing to your symptoms.
Treatment Women :
  • After childbirth, gentleness and patience should be exercised. Wait at least six weeks before resuming sexual relations.
  • Menopausal women may use lubricants and estrogen-containing creams or medications as prescribed.
  • Infections may be treated with antibiotics or antifungal medications. Specific treatments for viral infections like herpes and genital warts are also available.
  • Endometriosis may be treated with medications; in some cases, surgery is helpful.
Men
Most cases of prostatitis and urethritis respond to antibiotic treatment. Sitz baths and avoiding alcohol and caffeine may also be helpful for prostatitis. Sometimes surgery may be indicated to treat foreskin and other erectile problems.

When no organic (physiological) cause of the pain can be found, sex therapy may prove beneficial. Occasionally, variables such as guilt, inner conflict, unresolved feelings about past abuse, and the need for self-punishment may be involved and need to be worked through in psychiatric counseling.

Prevention:
  • Good hygiene and routine medical care will help to some degree.
  • Safe sexual practice will reduce the risk of herpes, genital warts, and pelvic inflammatory disease.
  • Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
  • The use of a water-soluble lubricants like K-Y® Jelly may also help. Vaseline® should not be used as a sexual lubricant since it is not water soluble and may encourage vaginal infections.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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