 |
 |
|
|
|
|
DESCRIPTION
Dyspareunia is recurrent and persistent genital pain associated with sexual intercourse. Dyspareunia and vaginismus (spasm of the pubic muscles of the lower vagina) are often linked. Pain during or after sexual intercourse can also affect men, but it is more common in women. Women may experience pain in the vagina, clitoris, or labia.
FREQUENT SIGNS AND SYMPTOMS
Dyspareunia is pain in the genital area during sexual activity, including foreplay, intercourse or attempted intercourse. Pain may be mild or severe, and it may vary with different intercourse positions. Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a common condition called vaginismus.
CAUSES
Physical causes include:
- Infection of the genitals, including herpes and others involving the vagina, cervix, fallopian tubes or ovaries.
- Urinary tract infections, vaginal yeast infections, or other sexually transmitted diseases.
- Pressure against the vaginal wall caused by scarring from operations or radiation treatment.
- Tight episiotomy scar from vaginal repair after childbirth.
- A fibroid or other uterine tumor.
- Skin diseases, such as lichen planus and lichen sclerosis, affecting the vaginal area.
- A hymen that is imperforate (not opened), torn or thicker than normal.
- A bruised opening to the urethra.
- Inadequate vaginal or condom lubrication.
- Allergic reactions to diaphragms, condoms or contraceptive foams and jellies. Allergic reactions to clothing or douches.
- Side effects of drugs such as antihistamines and tamoxifen (Nolvadex and other brands).
- Vaginal dryness or thinness (atrophic vaginitis) of the vaginal wall after menopause due to estrogen deficiency.
- Pelvic inflammatory disease.
- Endometriosis, a painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis.
Psychological and emotional causes include:
- Fear of pregnancy.
- Fear of injury to the unborn child during pregnancy.
- Lack of sexual arousal and vaginal lubrication caused by inadequate or insufficient sexual foreplay, aversion to a sexual partner, fatigue or anxiety.
- Lack of sexual experience or information.
- Past sexual injury or psychological trauma.
- Temporary lack of desire for a particular sexual partner.
MEN
In men prostatitis and urethritis are the most common causes of pain that occur at the time of ejaculation. Pain that occurs while obtaining an erection may be associated with:
- Inflammation of the foreskin.
- Loss of elasticity of the foreskin.
- Trauma to the penis.
- Herpes or genital warts.
- Local allergies or irritations.
- Curvature of the penis caused by Peyronie's disease
RISK INCREASES WITH
Pregnancy and the postpartum period.
Stress, recent illness.
Fatigue or overwork.
Alcohol consumption.
Menopause.
PREVENTIVE MEASURES
Obtain prompt medical treatment if you have symptoms of infection or the reproductive organs.
Discontinue use of contraceptive foams or jellies that produce allergic reactions.
Discuss the lack of sexual arousal with your partner, including ways to improve foreplay. Enlist your partner's support and patience to overcome the problem. Use a water-based non-allergenic lubricant, if necessary.
Obtain professional counseling to resolve feelings about past sexual trauma.
To decrease your risk of yeast infection, avoid tight clothing, wear cotton underpants and practice good hygiene. Change your underclothes after prolonged sweating. Bathing or shower daily, and change into dry clothing promptly after swimming.
To avoid bladder infections, wipe from front to back after using the toilet, and urinate after sexual intercourse.
To avoid sexually transmitted diseases, avoid sex or practice safe sex by maintaining a relationship with just one person, or using condoms to protect against sexually transmitted diseases.
To prevent vaginal dryness, use a lubricant, or seek treatment if the dryness is due to atrophic vaginitis.
If you have endometriosis, avoid very deep penetration, or have sex during the week or two after menstruation (before ovulation), when the condition tends to be less painful.
EXPECTED OUTCOME
How long your symptoms lasts depends on the cause. Medical disorders are usually curable with treatment. Psychological problems can often be cured with therapy, and interpersonal problems can improve with communication and patience. Women with long standing dyspareunia or a history of sexual abuse or trauma may need extensive counseling to alleviate the symptoms.
If you have vaginal dryness from inadequate lubrication, the symptoms will improve rapidly if you use a commercially available lubricant or if you are more aroused before intercourse. If you have vaginal dryness from atrophic vaginitis, your symptoms will improve with an estrogen cream placed in the vagina. You should discuss this with your health care provider. Oral estrogen therapy can increase the risk of breast cancer and heart disease, but vaginal formulas are considered safe for most people. If you have a urinary tract or vaginal yeast infection, the dyspareunia typically goes away within one week of antibiotic or anti-fungal therapy. If you have a sexually transmitted disease, you may need longer, more intensive treatments with antibiotics may be necessary to clear the condition. Skin diseases, usually will improve with the use of steroid creams, but often require long-term treatment. If you have had symptoms of dyspareunia for months or years, and psychological factors play a role, you may need prolonged counseling before your symptoms are relieved.
POSSIBLE COMPLICATIONS
Damage to personal relationships, permanent inability to enjoy sexual experiences and loss of self-esteem.
TREATMENT
GENERAL MEASURES
Dyspareunia typically is diagnosed based on your symptoms. Your medical and sexual history and your physical examination will help your health care provider to determine the cause of your symptoms.
Distinguishing pain that occurs with touching the genitals or early penetration from pain that occurs with deeper penetration is a clue to the cause of your symptoms. Therefore, your health care provider will ask you questions about the exact location, length and timing of your pain. He/she will also will ask you:
- If there was ever a time you had painless intercourse, or if you have always had dyspareunia.
- If you have enough natural lubrication, and if your symptoms improve if you use commercially available lubricants.
- About your sexual history (to help assess your risk for sexually transmitted infections).
- If you have ever been sexually abused, or had a traumatic injury involving your genitals.
- If you are middle-aged, your health care provider will ask whether you are experiencing irregular periods, hot flashes or vaginal dryness, symptoms suggesting that you may have atrophic vaginitis.
- If you are a new mother, your health care provider or midwife will ask whether you are breastfeeding your baby, because breastfeeding also can lead to vaginal dryness and dyspareunia.
During the physical examination, your health care provider will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), genital warts and scarring. Your health care provider also will do an internal pelvic examination to look for abnormal pelvic masses, tenderness or signs of endometriosis. He/she also may suggest that you speak with a counselor to determine whether a history of sexual abuse, trauma or anxiety may be contributing to your symptoms.
Laboratory studies, such as a Pap smear and culture of any vaginal discharge to diagnose any medical problem that can be treated.
Appropriate treatment will be directed to physical causes or psychological causes.
Sitz baths frequently relieve tenderness and painful inflammation. Sit in a tub of luke warm water for 10-15 minutes. Repeat baths as often as 3 or 4 times a day.
If vaginal dryness is the problem, you can ease penetration and sexual intercourse with increased clitoral stimulation before intercourse or lubrication with an non-prescription lubricant, such as baby oil or K-Y Lubricating Jelly, Replens or Astroglide lubrication during sexual intercourse. If you are using condoms for contraception, do not use any oil based lubricant since this may cause the condom to weaken and possibly break. Use water based lubricants only. Do not use Vaseline as a sexual lubricant since it is not water soluble and may encourage vaginal infections.
For atrophic vaginitis, estrogen therapy may be prescribed; either as a vaginal medication or as a oral pill.
Antibiotics will be prescribed or urinary tract infections or sexually transmitted diseases. For vaginal yeast infections, you will be given anti-fungal medications.
For dyspareunia caused by endometriosis, you may be prescribed medication or you may need surgical procedures to control or remove abnormal growths of uterine tissue.
For skin diseases affecting the vaginal area, the treatment will vary depending on the disease. For example, lichen sclerosis and lichen planus often improve with steroid creams.
For vulvar vestibulitis, typical therapies include topical estrogen cream, low-dose medications for pain, and physical therapy with bio-feedback to lower the muscle tension in the pelvic floor.
Instructions for exercises or techniques to dilate the vagina. They may involve use of fingers or dilators to condition the body and mind to the sensation of something being inserted into the vagina.
Try different positions for sexual intercourse to discover new ones that might reduce penile penetration and be pain-free.
Treatment for psychological causes where there is no apparent physical cause or if it has lasted for months or years, will vary depending on the needs of the patient. It can involve education about contraception, counseling to uncover hidden conflicts, address stress or anxiety regarding sexual intercourse, sensate focus exercises and teaching of appropriate foreplay techniques.
In cases of vaginismus or episiotomy scarring, a minor surgical procedure (e.g., perinoplasty) may relieve symptoms.
MEN
Most cases of prostatitis and urethritis respond to antibiotic treatment. Sitz baths and avoiding alcohol and caffeine may also be helpful for prostatitis. Sometimes surgery may be indicated to treat foreskin and other erectile problems.
When no organic (physiological) cause of the pain can be found, sex therapy may prove beneficial. Occasionally, variables such as guilt, inner conflict, unresolved feelings about past abuse, and the need for self-punishment may be involved and need to be worked through in psychiatric counseling.
MEDICATION
Antibiotic, antiviral, or anti-fungal medications for underlying infection may be prescribed.
ACTIVITY
No restrictions. A regular exercise program, while not a treatment for dyspareunia, is helpful in promoting general well-being.
DIET
No special diet.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Although sexual intercourse may be uncomfortable the very first time, it should never be painful. If you suddenly begin to have pain before, during or after intercourse, see your health care provider.
You or a family member has symptoms of dyspareunia. Seek care early, before you begin to avoid sexual intercourse or feel anxious in anticipation of your sexual partner.
Pain worsens, despite treatment.
Symptoms don't disappear after 3 months of treatment.
MoonDragon's Obgyn Information: Pre-menstrual Syndrome (PMS)
NOTE: Bulk herbs are available through Mountain Rose Herbs and Nutritional Supplements are available through Herbal Remedies. To find supplements not listed above, click on the links below:
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
Press your "back" button to return to the last page.
