Dyspareunia in Women: Causes, Diagnosis, and Treatment

Pain during intercourse (dyspareunia) is a common problem that can negatively affect marital quality of life and both psychological and physical health. The causes vary between physical and psychological factors, making accurate diagnosis and appropriate treatment essential for improving comfort and restoring intimacy. This article will define dyspareunia, its main symptoms, explain its various causes, diagnostic methods, treatment options, plus practical tips for symptom relief and improving marital relations.

 

What is Dyspareunia?

Dyspareunia, also known as painful intercourse, is defined as persistent or recurrent pain during sexual relations. The pain may occur at initial penetration, during intercourse, or after completion. It's more common in women, though it can also occur in men. The location and nature of pain varies; it may appear at the vaginal opening or deep in the pelvis for women. The pain can range from burning, stinging, throbbing, to tearing sensations or spasms in the genital or pelvic area. Dyspareunia doesn't only affect physical wellbeing but may extend to emotional and psychological aspects, potentially weakening feelings of intimacy and satisfaction between partners.

 

Symptoms of Dyspareunia in Women

If you experience pain during intercourse, you may encounter some of these symptoms:

• Pain during initial penetration
• Pain when inserting anything into the vagina, such as tampons
• Deep pain with penile movement during intercourse
• Burning sensation or aching during intercourse
• Persistent pain after intercourse, which may manifest as throbbing (a pulsating or mild continuous contraction in the area)

 

Common Causes of Dyspareunia

The causes of painful intercourse vary and may be related to physical or psychological factors, or both. Sometimes identifying the pain location helps determine the underlying cause.

 

Physical Causes:

Vaginal Dryness:

During sexual arousal, glands near the vaginal opening secrete natural fluids that help lubricate the area and facilitate intercourse. When this lubrication decreases, women may experience pain during sex. Vaginal dryness can occur for several reasons:

• Insufficient foreplay before intercourse, not allowing adequate time for natural preparation
• Decreased estrogen levels, especially after menopause or childbirth
• Certain medications that may affect natural secretions, such as:
• Cold and allergy medications: Like antihistamines that reduce mucous membrane secretions including vaginal discharge
• Hormonal medications that lower estrogen levels: Such as Medroxyprogesterone, commercially known as DEPO-PROVERA and PROVERA
• Antidepressants: Which may cause sexual side effects like vaginal dryness, decreased libido, and difficulty achieving orgasm

 

Infections:

Vaginal infections are among the common causes of dyspareunia, as they may cause burning or pain during intercourse. The most notable infections include:

• Yeast infections: May occur due to Candida overgrowth in the vagina. Signs may include:
• Itching or burning in and around the vagina
• Thick, white, cottage cheese-like discharge
• Redness and swelling in the vulvar area
• Burning during urination
• Small cracks or micro-tears in the skin from irritation

 

• While yeast infections aren't considered STIs, they may be transmitted to partners during direct contact.
• Bacterial infections: Occur due to imbalance in vaginal flora, potentially causing:
• White-gray or greenish vaginal discharge
• Fishy odor that worsens after intercourse
• Vaginal itching or irritation
• Burning during urination

 

Some sexually transmitted infections may also cause severe pain during intercourse, such as genital warts, herpes, or other STIs.

Dermatological Conditions:

Certain skin conditions like eczema can irritate genital skin, causing pain during intercourse. Any itchy skin condition like dermatitis may make intimacy painful and uncomfortable. Additionally, pain may result from skin irritation due to tight non-cotton underwear or use of harsh vaginal washes or scented hygiene products containing irritants.

 

Hormonal Changes:

Hormonal fluctuations can affect comfort during intercourse. During breastfeeding, increased prolactin and decreased estrogen levels reduce vaginal lubrication, potentially making intercourse less comfortable. Similarly, decreased estrogen during perimenopause may lead to vaginal dryness and increased likelihood of pain during sex.

 

Pelvic Floor Disorders:

The pelvic floor consists of muscles and ligaments supporting reproductive organs, bladder and rectum. When these muscles weaken or spasm, symptoms may emerge - most notably pain during intercourse. This condition is known as pelvic floor dysfunction and may cause pressure, discomfort, or localized pain during sex.

 

Endometriosis:

In this condition, tissue similar to the lining of the uterus grows in abnormal locations outside the uterus, such as the ovaries, fallopian tubes, or the area surrounding the uterus. This growth may cause tissue irritation and pelvic adhesions, leading to pain. Pain often occurs during or after sexual intercourse, especially if the endometrial-like tissue is near the vagina or rectum, where pressure or movement can stretch the affected tissue, resulting in discomfort or pain.

 

Psychological Causes of Dyspareunia:

Painful intercourse isn't limited to physical causes; psychological and emotional factors often play significant roles. Key factors include:

• Anxiety, fear and depression: These emotions negatively affect the body's response during intimacy, potentially causing vaginal dryness or pelvic muscle tension leading to pain.
• Stress and tension: Daily stressors may cause involuntary pelvic floor muscle tension, making intercourse painful and less comfortable.
• Negative body image: Body dissatisfaction or low self-confidence may reduce comfort during intimacy, negatively affecting enjoyment.
• Marital conflicts: Emotional tension or poor communication with partner may increase psychological stress during intercourse, potentially causing pain.

 

Diagnosing Dyspareunia

Diagnosis begins with detailed medical history including pain characteristics, timing, and associated physical or psychological factors. The doctor then conducts a comprehensive clinical exam including pelvic assessment, potentially examining abdomen, vagina and uterus depending on pain location and nature.

A gynecologist or family physician with sexual health expertise may order various tests including:

• Pelvic exam: Careful vaginal and cervical examination, potentially collecting vaginal discharge or urine samples for infection testing. Rectal exams may be performed when necessary.
• Ultrasound: Transvaginal ultrasound provides clearer visualization of internal reproductive organs like uterus and ovaries, aiding accurate diagnosis.
• Laparoscopy: In rare cases when other tests are inconclusive, doctors may perform laparoscopy - inserting a thin camera-equipped instrument through a small abdominal incision to directly visualize pelvic organs.

Additional tests may include blood work for infection or hormonal imbalance detection, plus other laboratory tests as determined by the physician.

 

Treatment Options

Treatment depends on the underlying cause, with physicians determining appropriate approaches based on accurate diagnosis. For pelvic floor muscle disorders, physical therapy may be the first recommended treatment to improve muscle function and reduce pain. For infections, treatment varies by type - antibiotics for bacterial infections and antifungals for yeast infections. For psychological causes like stress, anxiety or past trauma, cognitive behavioral therapy or referral to a sexual health specialist may help patients understand and overcome these issues in a supportive environment.

 

Managing Dyspareunia Symptoms

Beyond medical treatment, several home strategies may help alleviate pain during or after intercourse:

• Using water or silicone-based vaginal moisturizers to reduce dryness (available at pharmacies)
• Open communication with partner reduces stress and enhances feelings of safety and comfort
• Increasing foreplay duration allows for adequate natural lubrication
• Taking OTC pain relievers before intercourse (after medical consultation)
• Relaxation techniques before intimacy to reduce muscle tension
• Avoiding irritants like scented feminine products
• Applying cold compresses to genital area post-intercourse to reduce swelling
• Experimenting with comfortable positions (woman-on-top allows control over penetration depth)
• Pelvic floor exercises (Kegels): Contracting muscles as if stopping urine flow, holding for seconds, then relaxing. Regular practice improves muscle strength and relaxation.

 

Ultimately, dyspareunia is a manageable condition when properly understood and treated. Never ignore persistent pain or hesitate to consult a doctor - early diagnosis significantly improves outcomes. Attention to both physical and psychological health is fundamental for healthy marital relations.