Information From Your Health Care Provider

DYSPAREUNIA

Basic information

description

Dyspareunia is pain that occurs with sexual intercourse. Dyspareunia and vaginismus (spasm of the pubic muscles of the lower vagina) may occur together in a woman. Dyspareunia also occurs in men, but less often.

FREQUENT SIGNS & SYMPTOMS

Pain in the genital area during sexual activity. It can occur before, during, or after sexual intercourse.
Women may have pain on entry or during intercourse (with deep thrusts of partner's penis).
Men may have pain in the penis or testes.
Pain may be mild or severe, and vary with different intercourse positions.

causes

Physical and medical problems.
Emotional, interpersonal, and environmental problems (often referred to as psychosocial problems).
It may be a combination of factors. Sometimes no cause is found.

risk increases with

Physical:
- Infection, inflammation, or injury of the genitals or the urinary tract.
- A lack of vaginal lubrication. This can be due to illness, drugs, or lack of estrogen (such as at menopause).
- Vaginal scarring from operation or radiation therapy.
- Episiotomy scar (from repair after childbirth).
- Intact hymen (covering of the vaginal opening).
- Allergy to diaphragms, condoms, or contraceptive foams and jellies.
- Endometriosis or pelvic inflammatory disease.
- Muscle spasms of the vagina (vaginismus).
- Vulvodynia (chronic vulva pain).
- Tilted or enlarged uterus.
Emotional:
- Lack of sexual arousal or sexual foreplay, being unhappy with a sexual partner, fatigue, or anxiety.
- Lack of sexual experience or information.
- Past sexual abuse (e.g., rape) or emotional trauma.
- Fear of pregnancy.

PREVENTIVE MEASURES

Get medical care for genital infections.
Don't use perfumed soaps, bubble baths, or toilet paper that is scented or colored. Don't douche.
Get counseling for depression, stress, or anxiety.

expected outcomes

Physical causes are often curable with treatment. Psychosocial causes may be helped with treatment.

possible complications

Treatment may be long-term and may not always help. An intimate relationship with partner may suffer.

diagnosis & treatment

general measures

Your health care provider will do a physical exam and a genital exam. You will be asked about your symptoms and sexual history. Medical studies, such as a Pap smear and culture of vaginal discharge may be done to diagnose medical problems that can be treated.
Treatment will be directed to any physical or emotional cause that is diagnosed.
In cases of scarring, problems with the hymen, or others, a minor surgical procedure may relieve symptoms.
Sitz baths often relieve tenderness. Sit in a tub of lukewarm water for 10 to 15 minutes, 3 or 4 times a day.
Use a nonprescription lubricant, such as K-Y Lubricating Jelly, during sexual intercourse.
Instructions may be given for exercises or techniques to dilate (widen) the vagina. They involve use of fingers or dilators to condition the body and mind to the sensation of something being inserted into the vagina.
Try different positions for sexual intercourse that might reduce penile penetration and lessen pain.
Treatments for emotional causes will vary. They can involve education, counseling, sensate focus exercises, and teaching of appropriate foreplay techniques.
Discuss the lack of sexual arousal with your partner, including ways to improve foreplay.
To learn more: American College of Obstetricians and Gynecologists; website: www.acog.org.

medications

Drugs may be prescribed for infection or inflammation. Steroid creams or estrogen creams may be prescribed.

activity

A regular exercise program, while not a treatment for dyspareunia, is helpful for general well-being.