Understanding Dyspareunia: A Comprehensive Guide to Managing Painful Sex

Sex is fun, pleasurable, satisfying, and essential for a healthy life. But if you experience pain during sex, it can be devastating.

Painful sex is a common condition; about 20 per cent of women are affected by this problem at some point in their lives. Painful sex can affect anyone, but it affects women more commonly than men.

The condition can have a significant impact on your physical and emotional well-being. It can also impact your relationship with your partner if the problem isn’t addressed correctly.

What is painful sex or dyspareunia?

Dyspareunia is a medical term used to describe pain during sexual activity. Pain can be experienced before, during or after sexual intercourse.

This disease can affect anyone at any age and can vary in severity from person to person. Some people experience it only occasionally, while others experience it frequently and severely.

There can be pain at the initial entry of the vagina – superficial dyspareunia. The pain is felt in the vulva or vaginal opening. Usually, there is no cause for superficial dyspareunia in premenopausal women. However, several medical conditions can be associated with superficial dyspareunia and need investigation.

Deep dyspareunia is pain associated with deep penetration, and the pain is perceived in the vaginal canal or pelvic region. Deep Dyspareunia is often associated with endometriosis. Endometriosis is one of the main causative factors of deep dyspareunia.

Causes for painful sex

  1. Vaginal dryness – Vaginal dryness occurs when there’s insufficient lubrication in the vagina. The vagina naturally produces some lubrication during sexual arousal and foreplay. But if that natural lubrication isn’t there, you can get painful sex.
  2. Vaginismus –involuntary muscle spasms that cause the vaginal muscles to tighten so much that penetration is difficult or impossible.
  3. Vulvodynia (vulvar vestibulitis syndrome). This condition causes the chronic vagina and/or vulva pain and can cause burning, stinging, irritation and itching during intercourse. The pain is often worse during penetration and does not go away after sex.
  4. Menopause – During menopause, the ovaries stop producing estrogen and progesterone — hormones that lubricate the vagina. Without these hormones, vaginal tissues become thinner and less elastic, making intercourse painful.
  5. Vaginal or urinary infection – Bacterial vaginosis and yeast infections can cause pain during sex. The symptoms of these infections may include itching and burning in the vagina or a thick white or yellow discharge. A woman may also experience pain during urination or when she wipes herself after going to the bathroom.
  6. Endometriosis – Endometriosis occurs when endometrial tissue grows outside of the uterus. The most common sites are in the pelvis, such as the ovaries or bladder. Endometriosis can cause severe pelvic pain, but it can also cause deep dyspareunia.
  7. Pelvic flow issue – Infection, dysfunction or injury. PID – a bacterial infection in the uterus, fallopian tubes and/or ovaries that cause fever and pelvic pain with sex
  8. Stress or anxiety – if you experience persistent pain during intercourse without apparent physical causes, it can be due to stress or anxiety.

How to diagnose painful sex

You must talk to your doctor if you’ve been experiencing pain during sex. Your doctor will ask about your medical (including sexual) history and symptoms and perform a physical examination.

Several investigations need to be performed to determine the cause of pain and assess if there are any underlying diseases.

How to treat dyspareunia

Once you’ve determined the cause of your pain, treatment will depend on it.

Medications that can help with painful sex include topical estrogen creams or vaginal suppositories called moisturizers, inserted into the vagina before intercourse.

Over-the-counter pain relief medications such as paracetamol or ibuprofen can be used for severe pain.

Exercises (such as Kegel) to stretch and strengthen the pelvic floor muscles. Pelvic floor strengthening exercises are also helpful in preventing urinary incontinence and uttering prolapses.

The practice of relaxation techniques is helpful in the relaxation of vaginal muscles.

If the cause for painful sex is due to infection, appropriate antimicrobial treatment needs to be taken.

Sometimes surgery may be indicated to treat, such as endometriosis, to remove unwanted tissues or affected organs (uterus).

The Bottom Line

The best way to treat painful sex is to get a proper diagnosis.

Only a doctor can diagnose the cause of your pain and recommend the proper treatment for you.

If you’re experiencing painful sex, talk to your doctor about it.

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