Dyspareunia - Pain during sexual intercourse

General gynecology Dyspareunia – Pain during sexual intercourse

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Dyspareunia – Pain during sexual intercourse

bySherif Ashoush inGeneral gynecology posted20 September, 2022

Dyspareunia – Pain during sexual intercourse

Introduction

This complaint is different among women reporting it depending on the type or nature of pain and depending on its timing in relation to the act of sexual intercourse, or even depending on the site/location of pain in relation to the anatomy of the genital tract.

The causes may be psychological or organic, but the later should always be excluded before putting a final diagnosis or treatment plan.

Types of pain which may be met during sexual intercourse

There are different types of pain. For instance, there is a sensation of dryness in the vulva and vagina with a discomfort during movement of the male sexual organs. This is usually a complaint related to defective hormones. There is a superficial pain in the vagina, which is usually related to infections, but it may also be seen as a sharp well localized pain when related to a wound in the area, or a general poorly localized pain when related to venous congestion. On the other hand, a deep pain in the pelvis and upper genital tract may be seen with problems related to the womb, tubes or ovaries. Finally, there is a sharp type of pain caused by strong genital/pelvic muscle contractions which begin just prior or immediately at the beginning of the sexual intercourse, this may interfere or completely prevent the normal sexual life.

The site of pain may also predict its cause

The pain due to vaginal dryness may be due to physiological conditions such as during breast feeding or postmenopausal years and may be also seen with prolonged stress. It may also be seen after hysterectomy or with poor hormone effects as seen in cases with polycystic ovary syndrome (PCOS) or premature menopause or ovarian failure. It may be seen as a side effect of the use of anti-allergic or ovarian stimulation or contraception medicines.

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The superficial pain may be seen with vulvovaginal wounds or with vaginal infections. While the deep type of pain may be related to inflammation of the cervix (neck of the womb), tubes or ovaries whether this is due to endometriosis, pelvic inflammatory disease or infections. It may also be seen with uterine fibroids or ovarian cysts/swellings.

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Finally, vulvovaginal contractions (known as vaginismus) are usually related to psychological causes or excessive fear or misunderstanding of the nature of the sexual act.

Treatment of dyspareunia

The treatment differs depending on the cause of pain, women may try one or more of the following options:

Natural therapy including lubricants whether oil-based types such as K-Y gel or natural olive oil or water-based lubricants as YES-WB which are easier to use but have a shorter duration of effect. There are also products containing plant estrogen-like substances such as Evening Primrose Plus 1000 micrograms every 8-12 hours.

Medical treatment includes pain killing or anesthetic products. It also includes antimicrobial agents usually in the form of topical antibiotics or antifungal/antiviral medicines. This method also includes topical or systemic female hormone therapy or a more specialized type of hormonal treatment as Ospimefen 60 mg with fewer side effects or a medicine called Flibanserin 100 mg which raises the sexual desire of women when this is felt to be the cause of the problem. Local Botox injections may be helpful in cases with severe vaginismus.

Psychotherapy is also needed in some cases, it involves advice about different positions during intercourse, the use of gradual mechanical dilators and the use of acupuncture.