Dyspareunia refers to pain in the pelvic area during or after sexual intercourse. This can occur in both men and women, although it is more common in women.
Causes
Women
It is believed that dyspareunia is caused by physiological factors at least 75%-80% of the time.
Pain that occurs initially at entry but decreases over time is commonly caused by inadequate lubrication. This is frequently due to a lack of sexual arousal and effective stimulation or may sometimes be due to medication that decreases vaginal lubrication (such as antihistamines).
Psychological factors are infrequently involved and will most commonly be associated with previous sexual trauma (rape or abuse), feelings of guilt, or negative attitudes toward sex. These psychological factors may lead to a condition called vaginismus, that is described as painful rhythmic and involuntary contractions of vaginal muscles associated with fear of vaginal penetration.
Men
In men
prostatitis
and
urethritis
are the most common causes of pain that occur at the time of ejaculation. Pain that occurs while obtaining an erection may be associated with:
Inflammation of the foreskin
Loss of elasticity of the foreskin
Trauma to the penis
Herpes or genital warts
Local allergies or irritations
Curvature of the penis caused by Peyronie's disease
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Postmenopausal women and those taking medications that produce a vaginal dryness are at increased risk for dyspareunia.
Symptoms
Pain associated with dyspareunia may:
Occur during or after sex
Be itching, burning, stabbing, or aching
Be located in the:
Vagina
Urethra
Bladder
Pelvis
Penis
Testicles
Occur during all phases of sexual contact or only with deep thrusting
The diagnosis of dyspareunia is typically made based on your symptoms. Your medical and sexual history and your physical examination will help your doctor determine the cause of your symptoms.
During the physical examination, your doctor will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), genital warts, or scarring.
Your doctor will also perform an internal pelvic examination, looking for abnormal pelvic masses, tenderness, or signs of endometriosis.
Based on the results of the history and physical examination, your doctor may recommend further testing, such as cultures to detect infections or imaging studies such as pelvic ultrasound, to further investigate possible causes.
He or she may also suggest that you speak with a counselor to determine whether a history of sexual abuse, trauma, or anxiety may be contributing to your symptoms.
Treatment
Women
After childbirth, gentleness and patience should be exercised. Wait at least six weeks before resuming sexual relations.
Menopausal
women may use lubricants and estrogen-containing creams or medications as prescribed.
Infections may be treated with antibiotics or antifungal medications. Specific treatments for viral infections like herpes and genital warts are also available.
Endometriosis may be treated with medications; in some cases, surgery is helpful.
Men
Most cases of prostatitis and urethritis respond to antibiotic treatment. Sitz baths and avoiding alcohol and caffeine may also be helpful for prostatitis. Sometimes surgery may be indicated to treat foreskin and other erectile problems.
When no organic (physiological) cause of the pain can be found, sex therapy may prove beneficial. Occasionally, variables such as guilt, inner conflict, unresolved feelings about past abuse, and the need for self-punishment may be involved and need to be worked through in psychiatric counseling.
Prevention
Good hygiene and routine medical care will help to some degree.
Safe sexual practice will reduce the risk of herpes, genital warts, and pelvic inflammatory disease.
Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
The use of a water-soluble lubricants like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant since it is not water soluble and may encourage vaginal infections.
RESOURCES:
American College of Obstetrics and Gynecology http://www.acog.org
Family Doctor http://familydoctor.org/online/famdocen/home.html
CANADIAN RESOURCES:
Sex Information and Education Council of Canada (SIECCAN) http://www.sieccan.org/
Sexuality and You http://www.sexualityandu.ca/
References:
Heim LJ. Evaluation and differential diagnosis of dyspareunia.
Am Fam Physician
. 2001;63(8):1535-1544.
Griffith's 5-Minute Clinical Consult
. Lippincott Williams & Wilkins; 2001.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
