Dyspareunia - Types, Causes, and Management

Introduction:

Dyspareunia is a condition of persistent pain before or following a sexual encounter. It affects both men and women. However, it is more common in women. Dyspareunia has a complicated etiology, including physical, psychological, and social components. It can be present from the first sexual contact or evolve.

What Are the Different Types of Dyspareunia?

Dyspareunia can be classified into primary and secondary based on the onset:

1. Primary Dyspareunia -

• The onset is from the first sexual experience.

• The cause of primary dyspareunia is always associated with psycho-social causes such as sexual abuse during childhood and fear of sexual intercourse.

2. Secondary Dyspareunia -

• After years of regular sexual experience, the onset of dyspareunia occurs.

• Secondary dyspareunia is mainly caused by physical factors or a condition that produces bodily changes, such as menopause.

• Dyspareunia can be classified into persistent and conditional based on frequency.

• Dyspareunia can be termed persistent when discomfort happens with all partners and in all situations.

• It can be called conditional when symptoms appear just on certain occasions, with certain types of stimulation, or with a specific partner.

Dyspareunia can be classified into superficial and deep based on the anatomic site.

• Superficial-stinging and searing pain in the vaginal opening.

• Deep-on penile penetration, discomfort is felt within the pelvis.

What Are the Causes for Dyspareunia?

Dyspareunia can be caused by one or more of the following conditions:

• Menopause - During menopause, the vaginal mucous membrane thins and loses its firmness. The vaginal dryness caused by reduced discharge makes sexual intercourse uncomfortable and difficult.

• Endometriosis - Endometriosis is a chronic condition marked by pathological features such as endometrial glands in the anatomical sites and organs outside the uterine cavity.

• Vestibulodynia - Vestibulodynia is a condition in which there is peri vulva region (around the vagina) discomfort without significant or specific visual symptoms and is clinically identified as a neurological illness.

• Vulvodynia - Vulvodynia is a condition with vulvar discomfort without significant or specific visual symptoms and is clinically identified as a neurological illness.

• Vaginismus - This condition where muscle spasms make it impossible to penetrate.

• Interstitial Cystitis - A medical condition in which the patient experiences an unpleasant sensation such as pain, pressure, and discomfort considered to be related to the urine bladder. These symptoms must last at least six months to be termed Interstitial cystitis.

• Fibromyalgia - Fibromyalgia is a disorder in which muscle and tendon flexibility is lost. It primarily affects the entire muscle mass of the vaginal area, resulting in pain during intercourse.

• Irritable Bowel Syndrome (IBS) - Irritable bowel syndrome is a condition wherein a functional disturbance of motility in the small and large intestines.

• Skin Disorders - Eczema, a skin problem that affects the quality of the skin, can cause dryness in the vaginal region, causing pain during intercourse.

• Anxiety, Depression, and Other Psycho-Social Disorders can produce arousal issues, limit vaginal canal lubrication and cause pain during intercourse.

Do Males Suffer From Dyspareunia?

Dyspareunia is not gender-specific per se. It is seen in both men and women, but women have a greater predisposition. Dyspareunia in men can be because of one of the following reasons:

• Phimosis - The penile foreskin is too tight to be pushed back over the head of the penis in this situation.

• Prostatitis - A medical term to describe the inflammation of the prostate gland.

• Peyronie's Disease - It is a noncancerous disorder caused by fibrous scar tissue on the penis that causes twisted, uncomfortable erections.

• Testicular Cancer - Cancer of the testicles or testes.

• Sexually Transmitted Infections (STIs) - Candidiasis, often known as thrust, affects the head of the penis, producing irritation.

• Presence of any lumps, growths, and warts.

What Does Dyspareunia Feel Like?

The following are a few clinical signs and symptoms of dyspareunia:

• Dryness of the genital organ.

• Vaginal secretion burn.

• Persistent vulvar irritation,burn and pain.

• Recurrent intractable vaginal infections.

• Aversion to speculum examination.

• Painful sexual intercourse.

• Pelvic floor spasms.

• Decreased sex drive.

• The genital area feels swollen.

• Painful menstruation.

What Tests Are Done to Investigate Dyspareunia?

The tests used to diagnose dyspareunia are listed below:

• Vaginal Swab - To check the presence of any unusual microorganism likely to cause infection.

• Pelvic Ultrasound - To rule out endometriosis and other cystic conditions.

• Diagnostic Laparoscopy - Also called pinhole surgery, allows access to examine the internal structure.

How to Treat Dyspareunia?

The best way to deal with dyspareunia is by addressing the cause:

• Dyspareunia due to vaginal infection is treated by using specific antibiotics.

• Dyspareunia due to vaginal dryness is treated using water-based vaginal lubricants and increasing foreplay.

• The psychosexual assessment treats dyspareunia due to psycho-social factors such as depression or anxiety.

• Dyspareunia due to endometriosis requires excision of the growth.

• Dyspareunia due to laceration or physical injury is allowed to heal by itself or by using a topical anesthetic gel.

• Due to the onset of menopause, dyspareunia is treated by hormone replacement therapy, which can be pills, intradermal patches, or vaginal rings.

• Dyspareunia due to childbirth can be avoided by practicing pelvic floor exercises (Kegel's) and maintaining abstinence for about six weeks postpartum.

• Dyspareunia due to vaginismus can be relieved by using a clitoris dilator.

How to Avoid Dyspareunia?

Here are a few tips to avoid dyspareunia:

• Spend a little more time on foreplay, as lubrication of the vagina is a must and should be a requirement for comfortable intercourse.

• Stay fit, as overall health is related to sexual health.

• If a person has a reproductive tract infection, do not engage in sexual activity.

• Psycho-social causes such as anxiety and depression are often ignored, but they have deep-rooted causes and affect sexual health adversely.

When Should a Person With Dyspareunia Seek Medical Attention?

It is better to see a doctor if any of the following symptoms are present:

• Develop relationship issues.

• Have trouble attaining or maintaining an erection.

• It is difficult to ejaculate.

• Lack of sexual desire.

• Severe or sudden pain during intercourse.

Conclusion:

Sexual relationships are an essential component of life. Dyspareunia is a condition that affects not only one's bodily well-being but also one's ability to have sex. Dyspareunia is not something people have to live with; it can be cured when treated. It is advisable to seek medical help to resolve the issue soon.