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  • Dyspareunia

    (Painful Sexual Intercourse)

    Definition

    Dyspareunia refers to pain in the pelvic area. It occurs during or after sexual intercourse. Although this condition can occur in both men and women, it is more common in women.

    Causes

    Women

    The cause is believed to be related to physical factors at least 75%-80% of the time.
    Some pain occurs during vaginal entry but decreases over time. This is often caused by not having enough lubrication due to a lack of sexual arousal and stimulation. It can also be due to some medicines. Antihistamines can cause dryness. Frequent douching can also cause problems.
    Other causes in women include:
    The cause of dyspareunia may also be related to psychological factors, although this is less common. Some examples include:
    • Previous sexual trauma, such as rape or abuse
    • Feelings of guilt
    • Negative attitudes toward sex
    These factors may lead to a condition called vaginismus . This is painful and involuntary contractions of vaginal muscles. It is usually a response to past sexual trauma or other painful circumstances, but it can also be the result of chronic irritation from a physical cause.

    Men

    The most common causes of pain in men are:
    Pain occurs 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 Factors

    Factors that increase your chance of dyspareunia include:
    In women:
    • Being postmenopausal
    • Taking medicines that produce a vaginal dryness
    In men and women, viral or bacterial infections may be to blame.

    Symptoms

    Pain associated with dyspareunia may:
    • Occur during or after sex
    • Be itching, burning, stabbing, or aching
    • Be located in the:
      • Vagina
      • Urethra
      • Bladder
      • Pelvis
      • Penis
      • Testicles
    • Occur during all phases of sexual contact or only with deep thrusting
    • May also occur with tampon use—fabric absorbs natural vaginal lubricant
    Female Reproductive System
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    Copyright © Nucleus Medical Media, Inc.

    Diagnosis

    The diagnosis is often made based on your symptoms. Your doctor will take a medical and sexual history. A physical exam will be done.
    For women:
      Your doctor will check your vaginal wall to look for:
      • Signs of dryness
      • Inflammation
      • Infection
      • Genital warts
      • Scarring
      Your doctor will also do an internal pelvic exam to look for:
      • Abnormal pelvic masses
      • Tenderness
      • Signs of endometriosis
    For men and women:
    • Your doctor may suggest more tests. They may include cultures to find infections. Imaging studies like ultrasound may also be used.
    • You may be referred to a counselor. This will help to determine whether psychological issues may be a cause.

    Treatment

    Women

    • Your doctor may recommend that you use water-soluble lubricants or creams that contain estrogen. Other medicines may be prescribed, as well.
    • Infections may be treated with antibiotics or antifungal medicine.
    • Inflammation and dermatitis may be treated with topical or injectable corticosteroids.
    • Viral infections like herpes and genital warts will need to be treated.
    • Endometriosis may be treated with medicines. In some cases, surgery may be necessary.

    Men

    To treat prostatitis and urethritis, the doctor may recommend:
    • Antibiotic treatment
    • Sitz baths—soaking the hip and buttocks area in warm water
    • Avoiding alcohol and caffeine, which may be helpful for prostatitis
    Sometimes, surgery may be done to treat foreskin and other erectile problems.

    Men and Women

    When no physical cause of the pain can be found, sex therapy may be helpful. Some concerns need to be worked through in counseling. These may include:
    • Guilt
    • Inner conflict
    • Unresolved feelings about past abuse
    • Need for self-punishment

    Prevention

    • Wait at least six weeks before having sexual relations after childbirth. It may be necessary to use a lubricant because of hormonal changes causing vaginal dryness.
    • Use proper hygiene and get routine medical care.
    • Practice safe sex to prevent sexually transmitted diseases .
    • Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
    • Use a water-soluble lubricant. Vaseline should not be used as a lubricant. It is not water-soluble, and it may encourage vaginal infections.

    RESOURCES

    American Academy of Family Physicians http://familydoctor.org

    American Congress of Obstetricians and Gynecologists http://www.acog.org

    CANADIAN RESOURCES

    Sex Information and Education Council of Canada http://www.sieccan.org

    Sexuality and UThe Society of Obstetricians and Gynaecologists of Canada http://www.sexualityandu.ca

    References

    Dambro M. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

    Dyspareunia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 28, 2013. Accessed March 12, 2013.

    Female sexual dysfunction. The American Congress of Obstetricians and Gynecologists, Practice Bulletin No. 119 . April 2011.

    Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician . 2001;63(8):1535-1544.

    Lightner DJ. Female sexual dysfunction [review]. Mayo Clin Proc . 2002;77:698-702.

    Ryan K, Kistner R. Kistner's Gynecology & Women's Health . 7th ed. St. Louis, MO: Mosby, Inc; 1999.

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