Dyspareunia treatment
Dyspareunia or pain during intercourse is associated with sexual pain disorders which are perhaps the most extreme symptoms of female sexual dysfunction. Dyspareunia is simply any recurrent or persistent urogenital pain that is associated with sexual activity and may occur upon penetration, during intercourse and/or following intercourse. The term is usually used to describe pain on penetration, but it can occur during genital stimulation.
Causes of dyspareunia
A very common cause of sexual pain is vaginal dryness. The excitement phase of the sexual response cycle prepares the vagina for penetration by providing lubrication for the genitals. Lack of adequate lubrication can cause friction leading to pain, irritation, and rawness at the opening of the vagina. The walls of the vagina can also be irritated by penetration if lubrication is insufficient.
Causes of vagina pain therefore naturally include lubrication difficulties; lack of knowledge of sexual response; lack of arousal; urethral problems; postmenopausal atrophy; infectious or irritative vulvitis and vaginitis; intercourse too soon after surgery or childbirth; and psychological concerns mostly emanating from sexual traumas.
Pain in a specific area of the vulva or vagina could be as a result of hymenal ring difficulty/thickening; old scars, lesions, abscesses, chronic gland enlargement; genital herpes; intercourse too soon after surgery or childbirth; and infectious or irritative vulvitis and vaginitis.
Deep dyspareunia could result from several causes among which are masses or uterine enlargement; endometriosis; pelvic infection; postoperative adhesions; ovarian tumours or cysts; vaginismus and psychological concerns. Although retrograde uteruses have been said to cause dyspareunia, no proof supports this. Also, a very common cause is positional, with deep thrusting by the woman’s partner hitting an ovary.
Treatment of Dyspareunia
A lot of women experience pain for a variety of different reasons. Treatment would therefore be based on defining the probable cause of the dysfunction and these are often a blend of physical and psychological factors. When the problem is medical and can be identified, treatment tends to be fairly straightforward.
For pain due to inadequate lubrication, education about normal sexual functioning and the need and time for lubrication may help couples increase the pleasure of their sexual experiences. The use of over-the-counter supplemental water-soluble lubricant such as K-Y Jelly can help make sex more comfortable.
Postmenopausal vaginal atrophy can cause diminished vaginal lubrication; hormone replacement therapy is often the recommended choice of treatment. The additional use of vaginal cream containing estrogen if not contraindicated, may also help. In menopausal women, the addition of testosterone to the therapy provides additional benefits.
Pain in a specific area of the vulva or vagina requires a physical examination to discover the area and for appropriate treatment and medication to advocated. To reduce the risk of yeast infection, women should avoid tight clothing, wear cotton underpants and practice good hygiene.
It is worthwhile to note that some women have no specific disorder but always experience pain when the penis hits the cervix; this situation can only be avoided by less deep penetration which can be effected by a change in sexual positions, side-to-side or with woman on top, or using a pillow under her buttocks. Also, if the pain is deep in the pelvis, the cause may be a pelvic infection, endometriosis, ovarian tumour or cysts, or some other condition that should be investigated by a physician.
If no underlying medical cause is identified in a woman with dyspareunia, sex therapy may be helpful. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which need to be worked through in therapy. It may be best for both partners to see the therapist together.