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Dyspareunia

Dyspareunia – Causes, Diagnosis and its Treatment

 

Introduction

Dyspareunia is a condition of painful intercourse and can be seen in both men and women. The onset of pain may be at penetration, during coitus or after intercourse. This condition has many historic references and known to have physiological as well as psycho-social factors. Although common to both sexes, the incidences of dyspareunia are mostly observed in women due to frequent and enhanced hormonal changes. About 20% of women around the world are known to experience dyspareunia at some time in their lives.

Risk Factors

Given that every 1 out of 5 women 5% of men are known to suffer from dyspareunia, much research and development of treatments has been done for the condition. Even if there are no debilitating risk factors associated with dyspareunia, the psychosocial impact this condition can have on the patient as well on his/her partner is undeniable. Dyspareunia is also considered a symptom or indication of underlying physiological malfunctioning. If left untreated, it can completely demotivate the suffering partner from engaging in sexual activity and can thus damage the relationship as well.

Causes

Dyspareunia in Women

  • Fungal, yeast or bacterial infection: Different sorts of surface infections or imbalance in the natural fauna of vulva or vaginal area can result in dryness, pain, irritation and inflammation. While it may not be felt normally, intercourse can aggravate the pain and result in dyspareunia.
  • Anatomical variations: Some women have thickened and un-dilated hymen, hymen remnants or retroverted uterus. This can result in physical obstruction or discomfort at the time of coitus.
  • Injury or trauma: Women, who have undergone surgery to correct a vaginal condition or have suffered a pelvic injury, may also experience dyspareunia.
  • Estrogen deficiency: Mostly seen in menopausal women or women who aggressively use hormonal birth control, deficiency of estrogen leads to dryness of vagina. Without sufficient lubrication, vaginal surface can develop lesions or abrasions due to increased friction during intercourse. This can become a chronic cause of dyspareunia.
  • Endometriosis, Ovarian cysts, tumours, fibroids: Dyspareunia is considered a symptom of underlying medical disorders pertaining to the uterus, ovaries and cervix. Outgrowths or malignancies in reproductive organs can also cause pain during intercourse.
  • Vulvodynia: It is a chronic pain syndrome in vulva and can also be an underlying cause of dyspareunia.
  • Psychological: Women experiencing post-traumatic stress, anxiety or strained relationship cannot feel sufficiently aroused to participate in intercourse. If they still engage in sex, they can feel pain at penetration or during sustained coitus.

Dyspareunia in Men

  • Infections: Sexually transmitted diseases like Gonorrhoea or infections in bladder, prostate or seminal vesicles can cause pain either during ejaculation or cause burning sensation and pain after ejaculation.
  • Intestinal cystitis: This condition can also be an underlying cause for acute pain at the time of ejaculation.
  • Anatomical variations: An unusually tight foreskin and conditions like frenulum brevewhich is a short or tight frenulum, can also cause Dyspareunia in men.

Diagnosis

Dyspareunia is a condition which doesn’t have a clear physiological or psychological cause. The complexity of the condition is derived from it multifactorial causes. As a result, differential diagnosis is usually recommended in case of Dyspareunia. Doctors recommend observing the symptoms in patients for six months before recognising it as a condition and not just a passing phase of hormonal imbalance. Various diagnostic measures adopted include –

  • Vaginal or testicular external examination can be done to inspect for visible infections.
  • Anatomical variations can also be observed upon closed examination by the physician. In men, frenulum or foreskin related diagnosis is relatively simplistic. In women, evaluation or hymen, ovarian cysts or conditions like endometriosis require internal probing and diagnostic procedures such as laparoscopy.
  • Mid-stream urine samples can be evaluated for Urinary Tract Infection (UTI).
  • Medical history and blood plasma analysis for hormonal secretions is also done in women to evaluate the underlying cause of Dyspareunia.
  • In extreme situations, biopsy of the vulva region is also conducted to check for infections or any malignancies which may be causing pain during intercourse.
  • Recto-vaginal examinations can also reveal endometrial deposits which could be the cause of pain.
  • Psychological Dyspareunia is investigated with diagnosing the exact point and intensity of pain. Pain at the time of arousal, penetration, after sex or throughout sex can indicate varied underlying reasons.

Treatment of Dyspareunia

Based on the differential diagnosis, Dyspareunia can be treated by treating its underlying causes. In case of psychological causes of Dyspareunia, psychotherapy is advised by GPs. In case of genital infections, medical attention is provided for the disease and once the infection is cured, the pain of Dyspareunia also subsides. Conditions like anatomic variations or endometriosis, frenulum breve, ovarian cysts and tumours can only be treated surgically to cure dyspareunia. Lastly, for menopausal women, hormonal therapy to increase estrogen in body can cure or alleviate Dyspareunia related pain greatly.