Dyspareunia

September 1, 2011

Pain during or after sexual intercourse is called dyspareunia. Women with dyspareunia may experience pain in the labia, clitoris, vagina, or deep in the pelvis. There are many causes of dyspareunia, and most can be treated successfully. The pain of dyspareunia can vary from superficial pain at penile entry of the vagina, to deeper pain with full penetration or penile thrusts. Some women experience painful spasms of the vaginal muscles with intercourse known as vaginismus.

Some common causes of dyspareunia include vaginal dryness, skin conditions, endometriosis, infections, and psychological trauma. Vaginal dryness occurs because the normal increase in vaginal lubrication during sexual stimulation may be diminished at certain times in a woman’s life such as during breast-feeding or at menopause. This is caused by a lowered level of the female hormone estrogen. Certain medications can also cause vaginal dryness, including tamoxifen and antihistamines.

Certain chronic skin conditions, such as eczema and lichen planus, can cause irritation to the labial area. Similarly, allergic reactions to clothing or chemicals (such as bath preparations, laundry products, feminine hygiene products, contraceptive jellies and foams, or condoms) can lead to irritation and dyspareunia. A condition called vulvar vestibulitis is a chronic irritation of the tissue at the opening of the vagina.

In endometriosis, the cells in the lining of the uterus migrate up through the fallopian tubes and grow abnormally inside the pelvis. This may lead to pain with intercourse, painful menses (dysmenorrhea), and/or infertility. Infections such as urinary tract (bladder) infections, vaginal infections, and sexually transmitted diseases can all lead to pain during or after intercourse. Women who have experienced psychological trauma such as previous sexual abuse or sexual assault may later develop sexual difficulties, including dyspareunia.

A thorough history and physical examination will sometimes pinpoint the specific cause of dyspareunia. The physician will seek to understand the timing and circumstances of the pain, type of pain (superficial or deep, at penile entry or later during intercourse), and any improvements with changes in positions. The woman seeking evaluation for dyspareunia should have an accurate record of her current medications and previous medical and surgical history. The sexual history will be important to discuss, including any previous abuse, the onset of the symptoms, and whether any remedies have been tried (such as lubricants if vaginal dryness has been experienced).

The physical examination will require a thorough evaluation of the female genitalia, including the labia, clitoris, vagina, and pelvic organs (uterus, ovaries, and supporting tissues). Depending on the suspected cause of the pain, the physician will obtain cultures to detect infection or biopsies of chronically irritated tissue. If endometriosis is suspected, a surgical procedure known as laparoscopy may be necessary to look inside the abdomen in order to make an accurate diagnosis.

TREATMENT

The treatment should be aimed at the cause of the pain. Conditions leading to vaginal dryness can usually be successfully treated with lubricants (such as Astroglide) or estrogens in either oral or vaginal forms. Labial skin conditions are generally treated with medicated creams to reduce inflammation and by the avoidance of any clothing or chemicals leading to an allergic reaction. Vaginal and urinary tract infections are almost always successfully treated with the appropriate antibiotic or antifungal medication, either topically or orally. Endometriosis may require treatments that are either medical (medications to reduce or suppress growth) or surgical (to remove the abnormal growths).

Dyspareunia that results from previous psychological trauma or pain that remains undiagnosed after a medical evaluation, often requires psychological counseling. Therapists with specific training and interest in dyspareunia and other sexual disorders can provide effective treatment leading to improvement.

PREVENTION

To prevent the more common causes of dyspareunia, women should consider the following:

  1. If vaginal infections are a problem, avoid tight clothing. Wear cotton underwear and change to dry clothing immediately after swimming.
  2. To avoid urinary tract or bladder infections, wipe front to back after urinating, and urinate soon after intercourse.
  3. When vaginal dryness is noted, use lubricants to minimize further irritation.

SEE ALSO: Endometriosis, Sexual organs, Vaginismus

Suggested Reading

  • Eyler, A. E. (2000). Sexual function and dysfunction in women. In R. Rakel (Ed.), Saunders manual of medical practice (pp. 631-635). Philadelphia: W. B. Saunders.
  • Gabbe, S. G. (Ed.). (2002). Obstetrics: Normal and problem pregnancies (4th ed.). New York: Churchill Livingstone.
  • Johnson, R. V. (Ed.). (1994). Mayo Clinic complete book of pregnancy and baby’s first year. New York: Morrow.

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