Painful Sex (dysparaunia)

 

 Definition

Painful intercourse can occur for a variety of reasons — ranging from anatomical problems to psychological problems. A number of  women have painful intercourse experience at some point in their lives.
The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh) — which is persistent or recurrent genital pain that occurs just before, during or after intercourse.

 

 Symptoms

If you experience painful intercourse, you may feel:

• New pain after previously pain-free intercourse
• Burning pain or aching pain
• Throbbing pain, lasting hours after intercourse  
• Pain only at sexual penetration (entry)
•  Pain with every penetration, even while putting in a tampon 
• Deep pain during thrusting

 

 

Entry Pain 

 Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.

1.Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).
2.Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
3.Congenital abnormality. A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.
4. Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding. Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. 
5. Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.

Deep Pain 

 

Deep pain usually occurs with deep penetration and may be more likely with certain postures at time of intercourse. Causes include:

Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy,can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful. Emotional Factors Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain.
Infections and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.

Emotional factors 

The are a number of emotional factors leading to painful sexual experience,they include:
1.History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse,but if you have been abused, it may play a role. Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax,which can lead to more pain.
2.Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
3.Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain. ny pain in your body, you might start avoiding the activities that you associate with the pain.

Tests and diagnosis

A medical evaluation for dyspareunia usually consists of:

• A thorough medical history. Your GP may ask about onset of pain,site, intensity of pain, and if it happens with every sexual partner and every sexual position, any surgical history and past childbirth experiences.
  
  
• A pelvic exam. Done to check for signs of skin irritation, infection or anatomicalanomalies. Your GP may also try to identify the location of your pain by applying gentle pressure to your genitals and pelvic muscles.
  Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it's too painful.
  
• Other tests. If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.

 

Treatments and drugs

Treatment options vary, depending on the  cause of the pain.

Medications

If an infection or medical condition contributes to your pain, treating the underlying cause may resolve your problem. Changing medications known to cause lubrication problems also may eliminate your symptoms.
For many women who have undergone menopause, painful sexual intercourse is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to your vagina.
The drug ospemifene (Osphena) was recently approved by the Food and Drug Administration to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining, but doesn't seem to have estrogen's potentially harmful effects on the breasts or the lining of the uterus (endometrium). Drawbacks are that the drug is expensive, it may cause hot flashes, and it has a potential risk of stroke and blood clots.

Therapy

Different types of therapy may be helpful, including:

• Desensitization therapy. During this therapy, you learn vaginal relaxation exercises that can decrease pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse.
• Counseling or sex therapy. If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.
  Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.
  

Lifestyle and home remedies

You and your partner may be able to minimize pain with a few changes to your sexual routine:

• Communicate. Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
• Don't rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
• Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like. 
• Switch positions. If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.

Coping and support

Until vaginal penetration becomes comfortable, you and your partner might find other ways to be intimate. Sensual massage, kissing and mutual masturbation offer alternatives to intercourse that might be more comfortable, more fulfilling and more fun than your regular painful routine.

 
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