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Dyspareunia is a condition characterised by pain or discomfort during or after sexual intercourse (pain at entry). Individuals can experience pelvic pain, entry pain (sometimes deep pain), genital pain, lower abdominal pain, or lower back pain – the pain can range from mild to severe. In some cases, the pain may be severe enough to make intercourse unbearable, and this can lead to a decrease in sexual desire and difficulty becoming aroused. The prevalence of Dyspareunia is high but due to the lack of understanding of its symptoms and treatment, women with dyspareunia are unable to get the help they need. There are several potential causes of dyspareunia, including physical conditions such as endometriosis, pelvic inflammatory disease, and ovarian cysts, as well as psychological factors such as stress, anxiety, and depression.
In addition to physical pain, dyspareunia can also lead to emotional distress and relationship concerns. It’s also important to mention that it affects men and women differently, and the symptoms and causes may vary as well as the treatment options.
The diagnosis of dyspareunia is very important – treatment options can include medications, physical therapy, and psychological counseling. It’s important to note that the earlier you seek help the more likely you are to find the best option for you. There are medical treatments that can be very effective for this condition.
It’s also important to mention that prevention is key, and there are lifestyle changes that can help reduce the risk of developing dyspareunia. These can include maintaining a healthy weight, exercising regularly, avoiding smoking and excessive alcohol consumption, and practicing good hygiene.
In this lesson, we will explore some of the common causes of dyspareunia and what can be done to treat and prevent this condition.
Physical Causes Of Dyspareunia
Infections
Yeast Infections | ‘Thrush’
In men, the symptoms of yeast infection or thrush include uncomfortable symptoms such as itching, redness, and soreness on the glans (head) of the penis, and under the foreskin, discharge (commonly described as ‘cottage cheese discharge’), and pain or discomfort when pulling the foreskin back and forth – these combined can cause stinging during urination and also during sexual intercourse.
In women, the symptoms of vaginal yeast infection or thrush include uncomfortable symptoms such as vaginal discharge (commonly described as ‘cottage cheese discharge, vaginal itching, redness, and soreness – these combined can cause stinging during urination and also during sexual intercourse.
STDs | STIs
Certain STIs and STDs can cause pain, and burning sensations in the penis, testicles, and other organs. This is because the symptoms of some of the conditions can be sores, bumps, inflammation, redness, and swelling.
Sexual Dysfunction
Phimosis and Paraphimosis | ‘Tight foreskin’
In Phimosis, the foreskin of an uncircumcised individual can not completely be pulled back or retracted from the head of the penis. In Paraphimosis, the foreskin is retracted but can’t move back up to its original position, preventing healthy blood flow to the penis. Phimosis can lead to paraphimosis. Symptoms of the condition include inflammation, discolouration, pain or soreness around the penis head, during sexual activity, while getting an erection, or otherwise, pain during urination, and penis discharge due to irritation or infection.
Glans Penis Hypersensitivity
Most men who have an intact foreskin have a sensitive glans penis. When they have sexual intercourse the first few times, they can experience pain or discomfort when the foreskin gets pulled due to friction. While it may be common to have a sensitive penis, an oversensitive one can be painful and cause discomfort. Glans is the head of the penis, and hypersensitivity means that it can be too sensitive. In some cases, glans hypersensitivity can cause premature ejaculation and erectile dysfunction as well. The main symptom is pain or discomfort during sex or otherwise.
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Peyronie’s Disease
This condition results from the formation of penis scar tissue that can cause abnormal curvature or bending and painful erections. This can make it hard to have sex, as at times it can be difficult to maintain an erection leading to erectile dysfunction. Some of the symptoms of Peyronie’s Disease include scar tissue buildup that can be felt under the skin of the penis upon physical examination, and penis bend because due to the condition, the penis has an upward or downward curvature or bend, penis shortening and penile pain.
Vaginismus
Vaginismus and dyspareunia are two common conditions that can affect a woman’s sexual health. While they have some similarities, they are not the same thing and have different causes, symptoms, and treatment options.
Vaginismus is a condition in which the vaginal muscles contract involuntarily, making it difficult or impossible for a woman to have intercourse. This can be caused by a variety of factors, including psychological factors like anxiety or past trauma, as well as physical conditions such as vulvodynia or vaginal infections. Symptoms of vaginismus can include pain or burning during intercourse, a feeling of tightness in the vaginal area, and difficulty inserting a tampon.
Dyspareunia, on the other hand, is a condition characterized by pain or discomfort during or after intercourse. Unlike vaginismus, dyspareunia can be caused by a variety of physical conditions, such as endometriosis, pelvic inflammatory disease, or vaginal dryness. The symptoms of dyspareunia can include pain or discomfort in the pelvic area, a burning sensation in the vaginal area, and pain during or after intercourse.
It is important to note that both vaginismus and dyspareunia can be treated, and the treatment will vary depending on the underlying cause of the condition. In the case of vaginismus, pelvic floor physical therapy and counseling may be helpful, while dyspareunia may be treated with medication, hormone therapy, or surgery.
Overall, it is essential to consult a healthcare professional if you suspect you have either of these conditions. A proper diagnosis is essential for the appropriate treatment. With the help of the right healthcare provider, many women can find relief from vaginismus and dyspareunia and reclaim their sexual health.
Low Sexual Desire
Low sexual desire, also known as hypoactive sexual desire disorder (HSDD), is a condition characterized by a lack of interest in sexual activity. While low sexual desire can cause dyspareunia, it is not the only possible cause.
Low sexual desire can be caused by a variety of factors, including psychological factors such as stress, depression, or relationship concerns, as well as physical factors such as hormonal imbalances or certain medications. In some cases, the cause of low sexual desire is unknown.
Dyspareunia, on the other hand, is a condition characterized by pain or discomfort during intercourse. As mentioned, low sexual desire can cause dyspareunia as an individual may avoid sexual activity due to the lack of interest, but it can also be caused by other factors such as vaginal infections, endometriosis, vulvodynia, and others.
Treatment for low sexual desire may include counseling, sex therapy, or hormonal therapy. In some cases, medication may be prescribed to help increase sexual desire. It is important to note that low sexual desire can be a symptom of an underlying condition, and it is important to be evaluated by a medical professional to determine the underlying cause.
Treatment for dyspareunia caused by low sexual desire may include therapy for the underlying psychological concerns, and physical therapy. Medications may be prescribed to help with pain and in some cases, surgery may be an option.
Medical conditions
Prostatitis
This is the inflammation of the prostate gland – a gland only males have. The symptoms of the condition include pain around the penis, anus, testes, lower stomach, and lower back. It can hurt during urination and defecation – these symptoms alone can affect arousal (inadequate arousal or lack of arousal) and desire and can make it rather painful to engage in sexual intercourse.
Testicle pain/swelling
There are infections such as Chlamydia that can cause testicle pain and swelling, while other causes can include injury, an allergic reaction, or medication side effects. Various conditions can cause growths or lumps on the testicles such as hydrocele, varicocele, cysts, testicular torsion, epididymitis, and cancer.
Tears in foreskin
Tears in the foreskin can be caused by injury, or ‘rough sex’ and sometimes can’t be seen. However, it can causes ‘stinging’ pain and soreness which can make it painful during sex.
Vulvodynia
A chronic pain condition that causes vulvar pain. Vulvodynia can cause burning, stinging, and itching in the vulva, as well as pain during intercourse. Healthy and aware of your body can help to decrease your risk.
Menopause | Lack of Lubrication
Menopause is a natural biological process that marks the end of a woman’s reproductive years. It is characterized by the permanent cessation of menstrual periods, and is usually diagnosed after a woman has gone 12 months without a period. Menopause can bring a variety of symptoms, including hot flashes, night sweats, vaginal dryness, and mood changes.
One of the most common symptoms associated with menopause is dyspareunia, which is the medical term for painful intercourse. This can be caused by a number of factors, including vaginal dryness and decreased estrogen levels. The lack of estrogen causes the vaginal walls to thin and become less elastic, making intercourse uncomfortable or even painful.
The good news is that there are a number of treatment options available for women who are experiencing dyspareunia as a result of menopause. These include:
Vaginal estrogen therapy: This involves applying a low-dose estrogen cream, tablet, or ring directly to the vagina. This can help to inadequate lubrication, elasticity, and overall vaginal health.
Oral hormone therapy: This involves taking hormones, such as estrogen and progesterone, in pill form. While oral hormone therapy can help to alleviate some of the symptoms of menopause, it is not recommended as a treatment for dyspareunia as it may cause systemic side effects and increase the risk of certain health conditions such as breast cancer and stroke
Lubricants and moisturizers: Over-the-counter products such as these can help difficulty in lubrication and make intercourse more comfortable.
Pelvic floor muscle exercises: This type of exercise is also known as Kegel exercises. They can help to strengthen the pelvic muscles, which can in turn improve sexual function and reduce pain during intercourse.
Lifestyle changes: Avoiding certain irritants such as harsh soaps and bubble baths, staying hydrated and avoid alcohol or tobacco may also help to alleviate symptoms.
It’s worth noting that not all of the options may work for every woman and it is important to have a conversation with a healthcare provider to determine the best course of treatment for you.
Endometriosis
A condition in which the tissue that normally lines the uterus grows outside of it, can also cause dyspareunia. In this case, pain during intercourse can be caused by the tissue pressing against the organs in the pelvis, including the bladder and rectum.
Bacterial Vaginosis
Bacterial Vaginosis (BV) is a common condition that affects the vaginal microbiome and can cause a variety of symptoms, including vaginal discharge, itching, and odor. One less common symptom of BV is dyspareunia, or pain during sexual intercourse.
BV is caused by an overgrowth of bacteria in the vagina. The normal balance of bacteria in the vagina is disrupted, leading to the overgrowth of certain types of bacteria. The exact cause of this disruption is not well understood, but certain risk factors, such as multiple sexual partners, a history of sexually transmitted infections (STIs), and douching, have been linked to the development of BV.
The symptoms of BV can vary from person to person, but one common symptom is vaginal pain and discomfort. The pain can be exacerbated during sexual activity, leading to dyspareunia. BV-associated dyspareunia may be caused by the inflammation in the vaginal wall caused by bacteria overgrowth, and the symptoms can range from mild discomfort to severe pain.
BV can be diagnosed by a healthcare provider during a pelvic exam and confirmed through laboratory tests. The standard treatment for BV is a course of antibiotics, either in oral or topical form. But Probiotics are also a popular alternative treatment.
To prevent BV, it is important to practice good hygiene and safe sex. Women should avoid douching, which can disrupt the balance of bacteria in the vagina, and use condoms to reduce the risk of contracting STIs. Avoiding using scented soaps, powder or washes, also avoiding using tight pants, and practicing good hygiene are additional steps that can be taken.
Genital Ulcers
Genital ulcers are a common condition that can affect both men and women. These sores can develop on or around the genitals and can cause a variety of symptoms, including pain, itching, and discomfort during sexual activity. One of the most significant effects of genital ulcers is dyspareunia, a condition characterized by pain or discomfort during or after sexual intercourse.
There are several different causes of genital ulcers, including sexually transmitted infections (STIs) such as syphilis and herpes, as well as non-infectious conditions like Behcet’s disease and lichen sclerosus. Regardless of the underlying cause, genital ulcers can cause a significant amount of discomfort and pain, especially during sexual activity.
When a person has a genital ulcer, the sore can be sensitive to touch and can cause pain or discomfort during intercourse. The friction and pressure of sexual activity can also cause the ulcer to worsen or become more inflamed, leading to even more pain and discomfort. In some cases, the pain and discomfort caused by genital ulcers can be so severe that it makes sexual activity impossible.
Treatment for genital ulcers depends on the underlying cause. For example, if the ulcer is caused by an STI, antibiotics or antiviral medications may be prescribed to clear the infection. In cases of non-infectious conditions, medications to reduce inflammation and other symptoms may be used.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine and can cause a variety of symptoms, including abdominal pain, bloating, constipation, and diarrhea. While IBS is typically thought of as a gastrointestinal disorder, it can also have an impact on a person’s sexual health. One of the ways IBS can affect sexual health is through a condition called dyspareunia, which is defined as pain during or after sexual intercourse.
There are a number of ways that IBS can lead to dyspareunia. For example, the pain and discomfort associated with IBS can make a person feel less interested in sex, and can make it difficult for them to relax and enjoy sexual activity. Additionally, IBS can cause muscle spasms and cramping in the pelvic area, which can make intercourse uncomfortable or even painful.
Another way that IBS can cause dyspareunia is through the changes in bowel movements that are often associated with the disorder. For example, if a person with IBS experiences diarrhea or constipation shortly before or after sexual activity, this can make intercourse uncomfortable or even unbearable. Additionally, certain medications used to treat IBS such as antispasmodic can result in vaginal dryness which in turn can cause dyspareunia.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic condition that causes inflammation of the digestive tract. The inflammation can cause a wide range of symptoms, including abdominal pain, diarrhea, and weight loss. In addition to these common symptoms, IBD can also cause a less well-known complication called dyspareunia, which is pain or discomfort during sexual intercourse.
There are several ways that IBD can lead to dyspareunia. One of the most common is through the formation of fistulas, which are abnormal connections between the intestine and other organs or tissues. Fistulas can form between the anus and the vagina or between the bladder and the rectum, causing pain or discomfort during intercourse. In addition, IBD can cause the thinning of the lining of the rectum, making it more susceptible to tears or fissures, which can be quite painful.
Another potential cause of dyspareunia in IBD patients is the presence of scar tissue, which can form as a result of the inflammation and healing of the intestinal lining. Scar tissue can cause adhesions, which are abnormal bands of tissue that can bind organs together, causing pain during intercourse.
It is also possible that the psychological aspect of having a chronic illness like IBD can contribute to dyspareunia. The stress, anxiety and depression that often accompany the chronic nature of the disease can affect a person’s desire or ability to engage in sexual activity, and the pain from IBD can also lead to fear or avoidance of any activity that might cause pain or discomfort, including intercourse.
Managing dyspareunia caused by IBD often requires a multifaceted approach. Medications, such as anti-inflammatory drugs, can help reduce the inflammation and pain associated with the disease. Surgery may be needed to repair fistulas or remove scar tissue. Additionally, physical therapy or other types of counseling can help individuals cope with the psychological aspects of the disease, including the emotional impact of dyspareunia.
Urethral Syndrome
Urethral syndrome is a condition that affects the urethra, the tube that carries urine out of the body. The symptoms of urethral syndrome can include pain or discomfort while urinating, frequent urination, and discomfort in the pelvic area.
One of the potential complications of urethral syndrome is dyspareunia, which is pain or discomfort during sexual intercourse. This pain can occur in the vaginal area, the pelvic area, or the lower back, and can be severe enough to make intercourse difficult or impossible.
There are several ways in which urethral syndrome can lead to dyspareunia. One possible explanation is that the inflammation and irritation of the urethra caused by urethral syndrome can also affect the surrounding pelvic and vaginal tissues, leading to pain during intercourse. Another possibility is that the discomfort and pain caused by urethral syndrome can lead to anxiety and tension during sexual activity, which can then contribute to dyspareunia.
Urethral syndrome can be caused by a number of factors, including infections of the urinary tract, irritation from certain products or medications, and hormonal imbalances. Treating the underlying cause of urethral syndrome can help alleviate the symptoms and reduce the risk of complications like dyspareunia.
Lichen Sclerosis
Lichen sclerosus (LS) is a chronic, inflammatory skin condition that affects the vulva, anus, and penis. One of the symptoms of LS is dyspareunia, which is pain during sexual intercourse.
LS affects around 1 in 100 women and is more common in postmenopausal women, but it can also affect men and children. The exact cause of LS is unknown, but it is thought to be an autoimmune disorder in which the body’s immune system mistakenly attacks healthy skin cells.
Symptoms of LS include thin, white patches of skin on the vulva or penis, itching, burning, and pain. In advanced cases, the skin can become thin and fragile, and may tear or bleed easily. The skin may also become darker in color and develop scarring.
Dyspareunia, or pain during sexual intercourse, is a common symptom of LS. This pain can be caused by the thinning and fragility of the skin, as well as the itching and burning sensations. In some cases, dyspareunia can be so severe that sexual intercourse is impossible.
Treatment for LS typically includes the use of topical corticosteroids, which can reduce inflammation and help to thicken the skin. In severe cases, systemic immunosuppressants or immunomodulators may be used. When dyspareunia is present as a symptom, it is important to address this through therapy or counseling as well.
LS can be a difficult condition to live with, but with proper treatment, it can be managed. If you suspect that you or a loved one may have LS, it is important to see a healthcare provider for an accurate diagnosis and treatment plan.
It is also important for people to know about LS, its symptoms, causes, and treatment options. By educating people about this condition, we can help reduce the stigma and isolation that many people with LS experience, and help people to get the treatment they need to manage their symptoms.
Urinary Tract Infection
Urinary tract infections (UTIs) are a common ailment that can cause a variety of symptoms, including pain and discomfort while urinating. In addition to these typical symptoms, UTIs can also cause a condition known as dyspareunia, which is defined as pain or discomfort during sexual intercourse.
The connection between UTIs and dyspareunia is related to the location of the infection. UTIs most commonly occur in the lower urinary tract, which includes the bladder and urethra. However, in some cases, the infection can spread to the upper urinary tract, which includes the kidneys and ureters. When this occurs, it can cause pain and discomfort in the lower abdominal and pelvic areas, which can then lead to dyspareunia.
Risk factors for UTIs include:
History of UTIs
Being sexually active
Using certain types of birth control,
Being pregnant
Women are more likely to develop UTIs than men because of the shorter length of the female urethra, which makes it easier for bacteria to enter the bladder.
It’s important to note that UTIs and dyspareunia are not synonymous, UTIs is just one of the several causes that can lead to Dyspareunia, hence consulting with a medical professional is important to identify and treat the underlying cause.
Treatment for UTIs typically involves antibiotics to clear the infection and pain relievers to alleviate symptoms. In some cases, treatment for dyspareunia may also be necessary. Your healthcare provider can recommend a specific treatment plan based on the underlying cause of the dyspareunia.
To prevent UTIs, it’s important to drink plenty of water and urinate frequently to flush out bacteria. Women should also wipe from front to back after using the toilet to prevent bacteria from spreading from the anus to the urethra. In addition, avoiding irritating feminine products, such as bubble baths and scented soaps, can help reduce the risk of UTIs.
Pelvic Surgery
Pelvic surgery is a common procedure used to treat a variety of conditions, such as cancer, endometriosis, and pelvic prolapse. However, while pelvic surgery can be life-saving and improve the quality of life for many people, it can also cause a significant complication called dyspareunia.
There are several ways in which pelvic surgery can cause dyspareunia.
Nerve Damage: One of the most common ways is through nerve damage. During surgery, the nerves that control sensation and muscle contractions in the pelvic area can be damaged or cut. This can lead to decreased sensation and increased pain during sexual activity.
Adhesions: Another way in which pelvic surgery can cause dyspareunia is through adhesions. Adhesions are fibrous bands of tissue that can form after surgery, connecting organs and tissue together. These adhesions can restrict movement and cause pain during intercourse.
Scar Tissue: Scar tissue can also form after surgery and cause discomfort in the pelvic area.
Treatment options for dyspareunia caused by pelvic surgery can include physical therapy, pelvic floor muscle exercises, and pain management techniques such as nerve blocks or relaxation exercises. Medications such as topical estrogen, vaginal lubricants, and antidepressants can also be effective.
In some cases, it may be necessary to seek further treatment such as Vaginal reconstruction surgeries that can help to reduce pain, improve function, and enhance sexual well-being.
Psychological Causes And Emotion Factors Of Dyspareunia
Past Sexual Trauma
Sexual trauma, such as rape or child sexual abuse, can have a profound impact on a person’s emotional and physical well-being. One of the ways that sexual trauma can affect a person’s physical health is by causing a condition called dyspareunia, which is defined as pain during sexual intercourse.
Dyspareunia is a common problem among survivors of sexual trauma, and it can have a significant impact on a person’s quality of life. The pain associated with dyspareunia can be physical or psychological in nature, and it can make sexual activity uncomfortable or even unbearable.
The physical causes of dyspareunia include:
Injury to the genitals,
Vaginismus
Vulvodynia (chronic pain in the vulvar area).
Sexual trauma can cause injury to the genitals and lead to vaginismus and vulvodynia, which in turn can cause dyspareunia.
In addition to the physical causes, the emotional and psychological impact of sexual trauma can also contribute to dyspareunia. Survivors of sexual trauma often experience feelings of guilt, shame, and anxiety, which can make it difficult for them to relax and enjoy sexual activity. They may also develop negative associations with sex, leading to a decrease in sexual desire and sexual function.
Trauma-informed therapy is important for treatment of dyspareunia caused by sexual trauma. It can help the survivor to understand and process the traumatic event and provide coping mechanisms. Specific treatment options may include physical therapy, talk therapy, and medication.
It is important for people who have experienced sexual trauma to seek out help from trained professionals who are equipped to support them in addressing the complex psychological and physical effects of the trauma.
Emotional Factors
Emotional factors that can cause dyspareunia include stress, anxiety, depression, and past sexual trauma. These emotional concerns can lead to muscle tension and difficulty relaxing during intercourse, which can cause pain. In addition, negative thoughts and feelings towards sex can make it difficult for a woman to become aroused and or experience vaginal lubrication, leading to pain during intercourse.
Relationship Concerns
One of the most common psychological causes of dyspareunia is relationship concerns. When a person is experiencing relationship difficulties, it can lead to feelings of anxiety and stress, which can in turn affect their physical and sexual health. This can include a decrease in libido and an increase in pain during intercourse.
There are a variety of relationship concerns that can contribute to dyspareunia. For example, a lack of trust or communication in a relationship can lead to feelings of insecurity and anxiety, which can affect a person’s ability to relax and enjoy intercourse. Additionally, feelings of resentment or anger towards a partner can also lead to pain during sex.
Another way that relationship concerns can cause dyspareunia is through changes in sexual desire or behavior. When a person is experiencing relationship difficulties, they may lose interest in sex or may avoid sexual activity altogether. This can lead to a lack of stimulation in the vaginal area, which can in turn lead to pain during intercourse.
Treatment For Dyspareunia
Treatment options for dyspareunia will depend on the underlying cause of the condition. Not all cases require a pelvic examination. In cases of vaginal dryness, treatment may include
Using a water-based lubricant or a low-dose vaginal estrogen cream
Vulvodynia and endometriosis may require medication, such as a low-dose tricyclic antidepressant or a medication that suppresses estrogen, in order to reduce pain.
Pelvic inflammatory disease may require antibiotics.
For Psychological causes therapy like the following can be beneficial:
Cognitive-behavioral therapy (CBT)
Practice of sex therapy
Couples therapy may be beneficial
