Sexual Dysfunction Dyspareunia

Doctors define dyspareunia as pain during intercourse. Dyspareunia symptoms can be felt in the genitals, the pelvis or the lower back. Both men and women can experience dyspareunia, although rates of male dyspareunia are much lower than rates among women.

While we define dyspareunia in terms of painful symptoms, dyspareunia is not a disease in and of itself. Dyspareunia symptoms result from an underlying disease or disorder.

Physical Causes of Dyspareunia

Physical causes of dyspareunia range from a lack of lubrication due to inadequate foreplay to the physiological structure of the uterus.

Some of the most common causes of dyspareunia include yeast and bacterial infections. Dyspareunia symptoms caused by yeast or bacteria are usually felt in or close to the vagina.

Physical causes of dyspareunia include:

  • Allergies: An allergic reaction to condom latex or spermicides can cause dyspareunia symptoms.
  • Endometriosis: Endometriosis occurs when the inner lining of the uterus (the endometrium) grows outside of the uterus. Endometrosis is rarely the cause of dyspareunia.
  • Medication: Certain medications can reduce vaginal lubrication, including medication used to treat depression, allergies and hypertension (high blood pressure).
  • Menopause: Estrogen levels fall with the onset of menopause, resulting in less vaginal lubrication and thinner vaginal walls. Both conditions may result in dyspareunia.
  • Pelvic Floor Spasms: Pelvic floor myalgia are involuntary and uncomfortable or painful muscle spasms.
  • Physical Conditions: Ovarian cysts can cause dyspareunia symptoms. Scars from childbirth and abdominal surgery are also possible causes.
  • Tipped or Retroverted Uterus: Some women have a “tipped” uterus. Dyspareunia occurs if the penis makes contact with the cervix or uterus during intercourse.
  • Vaginismus: A condition that causes painful vaginal spasms and impaired vaginal lubrication is another source.
  • Vulvodynia: A medical condition that result in a tender or sensitive vagina can cause dyspareunia.

Other causes of dyspareunia include pelvic inflammatory disease, pelvic varicose veins and urinary tract or bladder infections.

Psychological Causes of Dyspareunia

Early dyspareunia theories centered around psychological explanations. Sexual abuse, partner relationships and depression have all been suggested as causes of dyspareunia. Evidence supporting psychological causes has been varied, and reports have been published both supporting and refuting this idea.

One theory holds that after a physical cause has resolved, the mind may continue to expect pain during intercourse and dyspareunia symptoms may continue. Such pain is just as real as dyspareunia with a physical cause.

Dyspareunia Symptoms

Pain during intercourse is the defining symptom of dyspareunia. Individual women describe dyspareunia symptoms in different ways.

Pain may be experienced as an ache upon penetration, or as a burning, tearing or ripping sensation. Depending on the causes of dyspareunia, symptoms may be felt at the vaginal opening, inside the vagina or deep within the pelvis.

Some women experience dyspareunia symptoms immediately upon penetration (in some cases inserting a tampon is also painful). Other women experience dyspareunia only during moments of intense thrusting.

Male Dyspareunia

Male dyspareunia does occur, but the condition is much more common among women. Male dyspareunia causes include:

  • a “bowed” erection
  • penile skin allergies
  • prostate gland infection
  • testicle infections
  • tight foreskin.

Dyspareunia Treatment

Dyspareunia treatment depends on the underlying cause of the pain. When bacterial or yeast infections cause dyspareunia, treatment with anti-fungal medications or antibiotics usually resolves symptoms.

Dyspareunia treatment for allergies requires the use of different birth control methods. Inadequate lubrication may be treated with water-based lubricants or extending foreplay.

Time may be all that is required for dyspareunia surgical scars, which tend to cause fewer symptoms over time.

Ovarian cysts may be reabsorbed over time or surgically removed. Surgery is also used to treat endometriosis.

If physical causes of dyspareunia are ruled out, counseling could be considered to treat possible psychological causes.

Dyspareunia and Physical Therapy

When pain is caused by injury, tension or structural abnormalities, physical therapy can help reduce dyspareunia symptoms.

Dyspareunia and physical therapy can include biofeedback and relaxation exercises to reduce symptoms. Depending on the root cause of the pain, dyspareunia and physical therapy may be pursued alongside other treatment options.

Resources

Alberto, D., Buxton, M., Chakerian, M., Cosby, A., Indman, P. D., Janowitz, L. R.,