Dyspareunia

 Dyspareunia: Painful Intercourse

 Dyspareunia: Painful Intercourse
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At some time in their life, most women experience pain when having sexual relations. This can be due to many different reasons. Usually, it goes away. However, if you always suffer pain when you have sex with your partner, you could have a treatable medical condition called Dyspareunia.

Dyspareunia: What Does It Mean?

Dyspareunia means that you feel pain either before, during, or after having sexual relations. This pain can take different forms and can be felt in different parts of your genitals. It can last a short time or for several hours. It is called Dyspareunia if you feel the pain every time you have relations, or if it keeps coming back. To receive a diagnosis of Dyspareunia you must have been experiencing pain during intercourse for at least six months.

Stats: How Many Suffer from this Disorder?

Many women are reluctant to seek help for this condition, so accurate figures are difficult to obtain. It is thought that between ten and twenty out of every one hundred women in the US experience painful intercourse at some time.

What Causes Dyspareunia?

Dyspareunia can have both physical and/or emotional causes. Discovering exactly when and where you feel the pain could help to determine the cause.

If you feel pain when your partner is entering into you at the beginning of relations, it could be due to-

  • Lack of lubrication. This can be due to not feeling very aroused, which can happen if there is no or little foreplay, It can also be due to low estrogen levels which often occurs after giving birth, while you are breastfeeding, or after reaching the menopause. Also, some medicines, like those for high blood pressure, depression, and some birth control pills can decrease your sexual desire, so you are not so well lubricated.
  • A urinary tract infection or an infection in your genital area can cause pain on penetration. As can eczema or other skin conditions in this zone.
  • This could be from an accident or a surgery.
  • This is when the muscles of the walls of the vagina have spasms which you have no control over.
  • Congenital abnormality. You may have been born with a partially formed vagina or with a membrane across part of the opening of the vagina.

If the pain that you experience occurs when your partner is deep inside of you, or when he penetrates with force, the causes could be-

  • A medical condition. These could include a retroverted or prolapsed uterus, fibroids on the uterus or ovarian cysts, pelvic inflammatory disease, endometriosis, irritable bowel syndrome, cystitis or hemorrhoids.
  • Scars from pelvic surgery or from having a hysterectomy.
  • Medical treatments, such as chemotherapy and radiation treatment for cancer.

Sometimes the pain you feel may not be due to a physical reason but an emotional one. Or, frequently it can be a bit of both. You may suffer pain during intercourse if you are anxious, depressed or unhappy in your relationship. Stress can cause the muscles of your pelvic floor to tighten causing pain. Also, if you have ever been physically or sexually abused this can be the reason.

Signs and Symptoms of Dyspareunia

The signs and symptoms of this condition vary from person to person, but it is characterized by repeated pain in the genital area during sexual intercourse.

What are the Common Behaviors/Characteristics?

Once you have experienced pain a few times, you may become more tense during sexual relations because you are worried that it is going to hurt again. That can lead to increased pain, and it is quite common to start avoiding having relations so as not to suffer the pain. This can be a vicious circle, and it is quite common to feel distressed and inadequate due to this condition.

If you are trying to get pregnant the pain can make this difficult and you may find that your personal relationships are suffering and that you may not feel good about yourself in general. The good news is that many causes of the pain are treatable and can be cured. If it is not possible to find the reason or cure it, therapy can help you to overcome or to learn how to minimize and to live with the pain.

One of the most common times for Dyspareunia to begin is after giving birth for the first time. Forty-one-percent of women experience pain during the first three months, and in twenty-two percent, it can extend for six months. This can be due to a combination of factors. Scarring or damage to the vaginal area during the delivery, a drop in estrogen levels causing dryness and the mental stress that giving birth can bring. In repeated cases, reconstructive surgery may solve the problem.

Testing: What are the Diagnostic Criteria Per the DSM 5?

“Genito-Pelvic Pain/Penetration Disorder”

  1. Persistent or recurrent difficulties with one (or more) of the following:
  2. Vaginal penetration during intercourse.
  3. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
  4. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as the result of vaginal penetration.
  5. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
  6. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
  7. The symptoms in Criterion A cause clinically significant distress in the individual.
  8. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:

  • Lifelong: The disturbance has been present since the individual became sexually active.
  • Acquired: The disturbance began after a period of relatively normal sexual function.
  • Specify current severity:
  • Mild: Evidence of mild distress over the symptoms in Criterion A.
  • Moderate: Evidence of moderate distress over the symptoms in Criterion A.
  • Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Dyspareunia vs Vaginismus

Vaginismus is due to muscle spasm in the vagina caused by contractions in the muscles of the pelvic floor over which you have no control.  Vaginismus is a common cause of Dyspareunia, but the actual term Dyspareunia applies to pain in any part of the genitals before, during or after penetration.

Example Case of Dyspareunia

Lizzie had enjoyed a normal, trouble-free sexual life from the age of eighteen until she was twenty-three. She then became pregnant with her first child with whom she experienced a long and rather traumatic vaginal birth. After birthing, her doctor advised against sexual intercourse for three to six months to allow complete healing. Lizzie’s partner was very understanding and supportive and did not insist on having relations.

After six months, however, Lizzie remained reluctant to resume their sexual activity. The first attempts were unsuccessful, and Lizzie experienced severe pain even before penetration was achieved. With the new baby taking up so much of her time, Lizzie’s partner began to feel unwanted and abandoned and Lizzie became depressed.  As time went on their relationship deteriorated and their sexual and affectionate times together disappeared completely.

Eventually, Lizzie’s partner convinced her to visit the doctor to see if there was a physical reason for the problem. Lizzie was sure that it was due to the scarring occurred during giving birth, but, upon receiving a physical examination, the doctor revealed that she had healed well.  Unable to find a physical reason for the pain he referred the couple to a sex therapist. She discovered that it was the anticipation of feeling again the pain that she had experienced during childbirth that was causing Lizzie to involuntarily tighten her pelvic and vaginal muscles. This was making penetration impossible. She started working with the couple in relaxation techniques and after just a few weeks of therapy, they were able to resume their sexual activities without pain.

Thanks to the therapy, and the support and understanding of her partner, Lizzie is a happy young mum who is now enjoying a full and normal sex life again,

Dyspareunia

How to Deal/Coping with Dyspareunia

Look out for These Complications/Risk Factors

Enjoying pain-free sex life should be the norm. If you begin to experience pain at any stage of the sexual act, and at any time during your life seek medical advice. There are many physical causes of Dyspareunia which can be treated will pills, creams, or in some cases surgery. Many of the emotional causes of the condition respond very well to therapies. Continuing to suffer the pain will only make things worse and the treatment more complicated. So, seek professional medical help to assist you to return to enjoying an active sex life again.

Dyspareunia Treatment

It is important to seek treatment as soon as possible to avoid aggravating the problem further. Do not be embarrassed or ashamed, your doctor is a professional who can help you to feel better in all aspects of your life.

When you visit your doctor, he will want to know your complete medical and sexual history. He will also want you to give him as much information as possible about exactly where and when the pain occurs. Think about how the pain feels. If it is a burning sensation this may indicate to the doctor a different cause than if it is a localized piercing pain or a general overall discomfort. Try to be as specific as you can. He will want to know if it hurts with the same intensity in different positions, and, if you have more than one sexual partner, he will want to know if the pain is the same with each one.

Even though you may feel uncomfortable talking about these things, the more information you can give your doctor, the more likely it is that he will be able to find what is causing the pain and how to treat it. Later on, the doctor will examine your pelvis and vagina and may request an ultrasound. If any of the tests are painful you can ask the doctor to stop. Some doctors will give you a mirror for the pelvic exam so that you can participate more in the examination and better understand what the doctor discovers.

Some women suffer pain from their first sexual experiment while others develop the condition later on. If you only started to suffer pain later in your sexual activities the doctor will probably ask you to try and remember if there was a specific event, time or person that provoked it the first time.

The appropriate treatment for the pain you suffer depends on the cause of the pain.

Possible Medications for Dyspareunia

  • If an infection is the cause your doctor may prescribe antibiotics.
  • A change of a prescribed medicine to one that does not produce vaginal dryness may help.
  • For women with low estrogen levels, an estrogen cream applied to the vagina can assist.
  • The drug ospemifene can be prescribed as it has many of the same effects as estrogen.
  • A capsule of another drug, prasterone, inserted each day in the vagina can help.

Home Remedies to help Dyspareunia

  • Try different positions, you may find that some are less painful than others.
  • Talk to your partner and tell them what feels good and what does not.
  • Taking it slowly and passing more time in foreplay can help vaginal lubrication and decrease pain.
  • Use a lubricant, there are many different ones available.

Living with Dyspareunia

Being loving and close with your partner does not have to include intercourse if it is too painful. Try other ways to enjoy intimacy like masturbating, kissing, giving each other massages. Look for support from internet groups of fellow sufferers.

Insurance Coverage for Dyspareunia

Your medical insurance may cover you for this condition depending on the causes and the prescribed treatment. Consult with your insurance agent to see if you can claim.

How to Find a Therapist

Ask your doctor to recommend a therapist who offers the kind of therapy which he feels would be best for you.

Desensitization therapy may help you to learn how to relax the muscles of the vagina which can alleviate the pain.

Sometimes, even when the cause of the pain has been identified and cured you may continue feeling pain. This is because you now associate the sexual act with pain and this may lead you to not wish to be intimate with your partner. Sex therapy or sex counseling with your partner can help to resolve these issues by encouraging conversation and increasing confidence in each other.

Cognitive behavioral therapy is sometimes recommended to help to break out of negative cycles of thought and behavior.

What Should I be Looking for in a LMHP?

Look for a therapist who offers the appropriate kind of therapy that your doctor has recommended. You can look up their webpage on the internet to learn more about the therapy so that you know what to expect. Look for a therapist that both you and your partner think you will feel comfortable with.  You will need to be able to communicate freely and have complete confidence in your therapist for the therapy to be successful.

Questions to Ask a Potential Therapist

  • How long will therapy last?
  • Will I come alone or with my partner?
  • How often will therapy take place?
  • Will I make a complete recovery?

Dyspareunia Resources and Support Helpline

National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml

National Alliance on Mental Health: https://www.nami.org/Find-Support/NAMI-HelpLine 1-800-950-NAMI (6264) or [email protected]

National Rehabilitation Information Center: https://www.naric.com/?q=en/content/resources-specific-disabilities

National Suicide Prevention Lifeline:  https://suicidepreventionlifeline.org/

1-800-273-8255 available 24 hrs a day

Crisis Text Line: Text “home” to 741741

American Sexual Health Association’s STD Hotline: 1-919-361-8488

Planned Parenthood U.S. National Sexual Health Hotline: 1-800-230-PLAN (7526)

Resources

  1. https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
  2. https://www.merckmanuals.com/professional/SearchResults?query=Dyspareunia&icd9=302.76%3b625.0
  3. https://www.aafp.org/afp/2001/0415/p1535.html
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426773/
  5. https://www.health.harvard.edu/womens-health/painful-sexual-intercourse-dyspareunia
  6. https://www.psychologytoday.com/us/conditions/genito-pelvic-pain-or-penetration-disorder-sexual-pain-disorder

About the Author Depression Alliance Staff

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