Dyspareunia

Melinda, aged 23, had recurrent vaginal infections.

Briony, aged 30, had vaginismus and had not had intercourse in three years of marriage.

Sandy, aged 32, had surgery to stretch her vagina and has scarring which hurts with sex.

Women more at risk for dyspareunia include those who are on medications that produce a general drying effect on body secretions and those who are postmenopausal (and who have vaginal dryness due to low estrogen level).
Pain that occurs initially at vaginal entry but decreases over time is commonly caused by inadequate lubrication. This is frequently due to a lack of sexual arousal and effective stimulation, and sometimes due to medication that decreases vaginal lubrication (such as antihistamines). Sometimes the pain can just be because the woman’s lover is aggressive or impatient!

Other causes in women include vaginitis (vaginal infections), endometriosis, cystitis or urethritis, back or pelvis problems, retroversion of the uterus, and chronic constipation, premature lovemaking following surgery (episiotomy) or child birth hemorrhoids, genitourinary tract infections (such as a bladder infection) and herpes sores.

Prevention:

Good hygiene and routine medical care will help to some degree. Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant since it is not water soluble and may encourage vaginal infections.

The nature of treatment and the outcome depends on the cause of the pain.

Questions to ask include:
– When did it develop?
– Is intercourse painful every time that it is attempted?
– Has intercourse always been painful?
– Is it painful for your spouse, also?
– Does the pain occur during entry?
– Specifically, where is the pain? (labia, vagina, entire pelvic area etc.)
– What have you done to try to make intercourse less painful?
– How well has it worked?
– What other symptoms are present?

For painful intercourse in women after pregnancy, gentleness and patience should be exercised. Wait at least 6 weeks before resuming sexual relations after childbirth.

For painful intercourse in menopausal women, use lubricants and estrogen-containing creams or medications as prescribed. (See also: menopause, non-medical alternatives to ERT).

For painful intercourse caused by endometriosis, medications are available.

Eventually dyspareunia inhibits sexual interest as well as responsiveness. In some cases vaginismus may occur, causing the vaginal muscles to involuntarily contract and clamp down as a self-protective way of avoiding the anticipated pain.

For more Information contact Dr Jan.

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