What Causes Dyspareunia (Painful Sex for Women)?

>> Thursday, July 17, 2014

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Dyspareunia is painful sex due to medical or psychological causes. This can affect up to one-fifth of women at some point in their lives, but, luckily, the causes are often reversible.

The diagnosis of dyspareunia is made when the patient complains of recurrent or persistent vulvar, vaginal or deep pelvic pain before, during, or after sexual intercourse. When pain occurs, it distracts from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the penis is painful.

Many times the original source of pain (a healing episiotomy, for example) is gone but, because we anticipate that we will still feel pain, we stress and tighten our pelvic muscles and cannot relax. This can cause continued pain and is the most common reason for emotional pain.

Complaints of sexual pain will typically fall into one of three categories:

1) When there is pain during initial penetration, it is usually associated with a range of factors like insufficient lubrication from too little foreplay or by a drop in estrogen levels from menopause or breastfeeding. When there is a lack of estrogen, it causes pain from inability to make the natural lubrication or "wetness" when sexually excited. And, the vagina also can't stretch normally or at all. This is called vaginal atrophy, which is the thinning, fragility, shrinkage and dryness of the vaginal tissues. Of course, this causes pain when trying to let the erect penis in.

Pain with penetration can also come from injury due to pelvic surgery, female circumcision, child birth, episiotomy or a congenital birth defect like a thickened hymen.

Chronic skin irritation from yeast, urinary tract or bacterial infection, and eczema that occurs around the vagina and urethra can also cause pain during sex.

Disorders like interstitial cystitis, Lichen Sclerosis, external yeast infections and (rarely) Sjögren's syndrome can also cause excruciating pain and vaginal dryness.

Medications that inhibit desire or arousal and cause a decrease in vaginal lubrication (and resulting increasing pain with sex) include: antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. You can talk to your doctor about these and hopefully change them if needed.

2) Younger women with dyspareunia seem to have pain with pressure on the outside around the labia, pubic bone and vulvar area where most of the hair grows - causing a burning or a cutting type of pain.

3) Deep pain that comes with pushing deep inside and thrusting against the cervix may be more pronounced with certain sexual positions. This can be caused by infections (of the vagina, lower urinary tract, cervix or fallopian tubes), chlamydia, gonorrhea, coliform bacteria, PID (pelvic inflammatory disease), endometriosis, surgical scar tissue, uterine and vaginal prolapse, pelvic congestion, irritable bowel syndrome, retroverted uterus, uterine fibroids, cystitis, diverticulitis, appendicitis, hemorrhoids, ovarian cysts or other tumors.

Because there are numerous physical conditions that can contribute to pain during sex, a careful physical examination and medical history are always indicated.

It can help a lot if you know where you like to be touched so that it feels good. Try to add pleasant, sexually exciting experiences such as bathing together or mutual caressing without intercourse.

Lots of kissing on the lips and all over each other's body, including oral sex may relax and lubricate the vagina. Oral sex may also be an alternative, as it may be pleasurable without pain at all. Trying a change in your sexual positions may also help. Be sure to talk about what feels good and what doesn't. If you need your partner to go slow, say so. Don't rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused. Lots of couples just don't talk out of embarrassment, shyness or awkwardness about telling your partner what you like and what you don't like (or what hurts).

Remember, if you are embarrassed about vaginal odor or discharge, you can talk to your gynecologist and check out WaterWorks if you do not have an infection that needs to be treated. WaterWorks is FDA cleared for clearing vaginal odor and for routine feminine hygiene. It is a safe way to cleanse your vagina so you can feel confident during sex.
I hope you are all well and happy. Take care and be safe out there.

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