Impotence - Dyspareunia (pain With Sexual Intercourse)
Dyspareunia (pain With Sexual Intercourse)
What Is It
Dyspareunia is pain during sexual intercourse in either men or women. In women, dyspareunia refers to pain in a woman's vagina, clitoris or labia during or after intercourse. In men, the term refers to pain in the penis upon erection, during intercourse or during ejaculation.
There is no single cause of dyspareunia, but many contributing factors. Among women, common culprits include vaginal dryness; a urinary tract infection; a vaginal yeast infection; a sexually transmitted vaginal infection; an allergic reaction to spermicides, douches or clothing; endometriosis, a condition in which stray tissue from the uterine lining grows abnormally inside the pelvis; pelvic inflammatory disease; and severe tightening of the vaginal muscles due to psychological trauma (often linked to sexual abuse). Among men, common causes include irritation from spermicides or clothing, inflammation of the urethra or prostate, peyronie's disease (extreme curvature of the penis), or a sexually transmitted infection.
In women, dyspareunia appears as pain around the entrance of the vagina at the time of penetration and/or during penile thrusting and when the genitals are touched. In some women, there may also be pain deeper inside the vagina, with or without a severe tightening of the vaginal muscles.
Among men, dyspareunia appears as pain in the penis upon erection, during intercourse or during ejaculation.
What Your Doctor Looks For
Your doctor will ask you about the specific location, timing and duration of your pain. He or she will also ask about your sexual history (to help assess your risk for sexually transmitted infections), and about any history of genital trauma or sexual abuse. If you are a middle-aged woman, your doctor will ask about any history of hot flashes or irregular menstrual periods, since dyspareunia can result from the vaginal dryness produced by hormonal changes during menopause. If you are a new mother, your doctor will ask whether you breast-feed your baby, since breast-feeding can also lead to vaginal dryness and dyspareunia.
Your doctor can usually diagnose dyspareunia based upon your symptoms, your medical and sexual history and the results of your physical examination (including a pelvic exam in women).
If you are a woman, your doctor will examine your vaginal wall for signs of inflammation, infection (especially yeast or herpes infection), genital warts or scarring. During the pelvic exam, your doctor will also check for abnormal pelvic masses, tenderness or signs of endometriosis. If you are a man, your doctor will look for signs of inflammation of the urethra or the prostate. He or she will also check for peyronie's disease, as well as for physical signs of sexually transmitted disease (especially genital warts or herpes). In patients of either sex, if no physical abnormalities are found, your doctor may refer you to a counselor to determine if the cause is related to severe anxiety that may affect sexual performance.
The duration of dyspareunia depends upon the underlying cause. If the cause is simple vaginal dryness, a water-based lubricant (K-Y Jelly) can usually relieve the problem immediately. If the cause is a urinary tract infection or a vaginal yeast infection, the dyspareunia often resolves within seven to 10 days after treatment with antibiotics and anti-yeast medications. In patients with sexually transmitted infections, longer and more intensive treatments with antibiotics may be required to clear the condition.
In men with peyronie's disease, dyspareunia generally resolves on its own within six to 15 months, even without treatment.
To prevent dyspareunia caused by yeast infection, doctors recommend practicing good hygiene, with a daily bath or shower; changing underclothes after prolonged sweating; and changing into dry clothing promptly after swimming. To prevent dyspareunia caused by sexually transmitted diseases, health experts suggest choosing abstinence, having a monogamous sexual relationship with only one uninfected partner or practicing safer sex by using either male or female condoms.
Also, women with endometriosis can learn to control dyspareunia by either avoiding very deep penetration or by having sex during the week or two after menstruation (before ovulation), when the condition tends to be less painful.
Treatment depends on the cause of dyspareunia, and it may include antibiotics to clear infections, sitz baths to relieve painful inflammation and lubrication to ease penetration and sexual intercourse. In women whose dyspareunia is related to endometriosis, medications and/ or surgical procedures may be used to control or remove abnormal growths of uterine tissue. In patients who show no apparent physical cause of dyspareunia, the doctor may recommend psychological counseling to address stress or anxiety regarding sexual intercourse.
When To Call Your Doctor
Although sexual intercourse may be uncomfortable the very first time, it should never be painful. If you suddenly begin experiencing pain before, during or after intercourse, see your doctor.
About 90 percent of dyspareunia cases are rooted in a physical condition that can be cured or controlled with proper medical care.
For additional information about dyspareunia and other sexual health diseases, you can contact:
American College of Obstetricians and Gynecologists
409 12th St., S.W., pO Box 96920
Washington, D.C. 20090-6920
phone: (202) 863-2518
American Urological Association Headquarters
1120 North Charles Street
Baltimore, MD 21201
phone: (410) 727-1100