Intercourse Pain (Dyspareunia): Root Causes and Remedial Measures

Intercourse Pain (Dyspareunia): Root Causes and Remedial Measures

Dyspareunia, a condition characterised by persistent or recurrent pain during sexual intercourse, can stem from a combination of physical and psychological factors. This article provides an overview of the most common causes and available treatments for each.

## Common Physical Causes

Vaginal dryness and insufficient lubrication, often due to hormonal changes such as postpartum or menopause, can lead to discomfort or pain during penetration. Infections, such as urinary tract infections (UTIs), yeast infections, sexually transmitted infections (STIs), and pelvic inflammatory disease (PID), can also cause pain. Chronic pelvic conditions, including endometriosis, ovarian cysts, fibroids, and interstitial cystitis/bladder pain syndrome (IC/BPS), can lead to deep pelvic pain or cramping during or after sex. Pelvic floor muscle dysfunction, caused by overactive or tight muscles, can result in pain due to involuntary spasms or tension. Structural abnormalities, such as congenital anomalies, scar tissue from episiotomy, tearing during childbirth, or webbing of the labial commissure, are less common but can interfere with comfortable intercourse. Overuse injuries and medical devices, like previous surgeries or overuse of surgical meshes or slings, can contribute to pain.

## Common Psychological and Emotional Causes

Stress and anxiety about pain itself, performance, intimacy, or relationship issues can increase muscle tension and worsen pain. Past trauma, such as a history of sexual abuse or childhood trauma, can lead to chronic pelvic pain and difficulty engaging in sexual activity. Negative body image and self-perception, often due to changes after childbirth or due to chronic illness, can impact sexual desire and comfort. Pain expectancy and fear can create a feedback loop where fear increases muscle tension, which in turn increases pain.

## Available Treatments

Treatment for physical causes may include the use of water-based lubricants, hormone replacement therapies (HRT), or vaginal moisturizers for vaginal dryness. Prompt treatment with antibiotics, antifungals, or antivirals, depending on the underlying infection, is essential for infections. For chronic conditions, pain management strategies, medical treatments, or surgical intervention for severe cases may be necessary. Pelvic floor physical therapy, which includes exercises to relax or strengthen muscles, biofeedback, and manual therapy, can help address pelvic floor muscle dysfunction. Surgical correction for congenital issues, scar revision, or other procedural interventions as needed can address structural abnormalities. Adjustment, removal, or replacement of surgical meshes or slings if they are causing pain can address overuse injuries.

Psychological and emotional causes can be addressed through individual or couples therapy, mindfulness, cognitive behavioral therapy (CBT), stress management techniques, and open discussions about sexual expectations and comfort, including modifications in sexual positions and non-penetrative sexual activities.

An integrative approach, combining physical therapy, lifestyle modifications, positional modifications, non-penetrative sex, and education, can also be effective.

In summary, addressing dyspareunia often requires a holistic approach that considers both physical and emotional health to break the cycle of pain and restore sexual well-being. Treatment for dyspareunia focuses on the underlying cause. Medical conditions such as cystitis, endometriosis, fibroids, interstitial cystitis, irritable bowel syndrome, ovarian cysts, pelvic inflammatory disease, uterine prolapse can cause dyspareunia. Telling the doctor when and where the pain occurs during the examination may help identify the cause. Dyspareunia affects up to 20% of American women and can cause distress and relationship problems. Symptoms of dyspareunia include pain at the vaginal opening or deep in the pelvis, ranging from moderate to severe and causing discomfort or a variety of sensations such as aching, burning, throbbing, or ripping. The doctor may use a device called a speculum during the examination, which can cause some discomfort or pain to women with dyspareunia. A pelvic ultrasound may help detect structural abnormalities, endometriosis, fibroids, or cysts.

1. Chronic sclerosis, such as endometriosis or interstitial cystitis, can lead to deep pelvic pain or cramping during or after sex.
2. Insufficient lubrication due to vaginal health issues like atrophy can cause discomfort or pain during penetration.
3. Psoriatic disease or psoriasis, affecting skin health, might not directly cause dyspareunia, but can impact self-perception and sexual desire.
4. Crohn's disease, an inflammatory bowel disease, can sometimes cause discomfort during sexual intercourse.
5. The predictive value of noticing when and where the pain occurs during sexual activity can help identify the underlying cause.
6. Availability of treatments for cancer, like hormone replacement therapies (HRT) or surgical interventions, may indirectly alleviate dyspareunia for women undergoing cancer treatments.
7. Arthritis, specifically pelvic inflammatory arthritis, can potentially lead to difficulties during sexual intercourse due to joint pain.
8. Seeking help from health-and-wellness professionals or women’s health specialists can provide suitable treatments for dyspareunia.
9. Multiple sclerosis, a disease of the nervous system, can cause vaginal dryness and other pelvic issues, leading to dyspareunia.
10. Migraines, a neurological condition, may not directly lead to physical discomfort during intercourse, but emotional and psychological factors associated with migraines might have an impact on sexual health.

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