Dyspareunia

Refers to painful sexual intercourse due to medical or psychological causes.

The pain can be on the external surface of the genitalia, or deeper in the pelvis upon pressure against the cervix.

The discomfort can be limited to a small portion of the vulva or vagina or be felt throughout the pelvis.

Commonly, physical, psychological, and social relationship causes can contribute to pain during sexual encounters.

The pelvic pain can be acquired or congenital.

Symptoms may also occur after menopause.

Diagnosis is typically by physical examination and medical history.

Underlying causes determine treatment.

The possible role of psychological factors in either causing or maintaining the pain must be considered.

Estimated to affect between 8–21% of women, at some point in their lives.

The location, nature, and time course of the pain that patients experience may help to understand causes of and treatment for dyspareunia.

Some women feel pain in more than one place.

Determining whether the pain is more superficial or deep helps in understanding what may be causing a woman’s pain.

Some women experience pain with intercourse from their very first attempt, while others begin to feel pain with intercourse after an injury or infection or with menstruation.

The pain may increase over time.

Associated with decreased vaginal lubrication and vaginal dilation decrease, and distraction from feeling pleasure and excitement.

Vaginal penetration is more difficult and painful.

Fear, avoidance, and psychologic distress associated with intercourse can occur.

Fear, avoidance, and psychologic distress around attempting intercourse can become problematic.

Physical examination of the vulva may reveal clear sources for pain include: thin skin, ulcerations or discharge associated with vulvovaginal infections or vaginal atrophy.

An internal pelvic exam may reasons for pain including lesions on the cervix or anatomic variation.

The cause of the pain may be anatomic or physiologic.

Lesions of the vagina, retroversion of the uterus, urinary tract infection, lack of lubrication, scar tissue, abnormal growths, psychosomatic reasons which can include fear of pain or injury, guilt or shame, ignorance of sexual anatomy and physiology, and fear of pregnancy.

Common causes for discomfort during sex include: Infections that mostly affect the labia, vagina, or lower urinary tract like yeast infections, chlamydia, trichomoniasis, urinary tract infections, or herpes tend to cause more superficial pain.

Infections of the cervix, or fallopian tubes like pelvic inflammatory disease tend to cause deeper pain.

Cancer of the reproductive tract, including the ovaries, cervix, uterus, or vagina.

Tissue Injury. Pain after trauma to the pelvis from injury, surgery or childbirth.

Anatomic abnormalities. hymenal remnants, vaginal septa, thickened undilatable hymen, hypoplasia of the introitus retroverted uterus or uterine prolapse can contribute to discomfort.

Hormonal causes, such as endometriosis and adenomyosis
May be related.

Estrogen deficiency is a common cause of sexual pain complaints related to vaginal atrophy among postmenopausal women, as is lubrication inadequacy, which can lead to painful friction during intercourse.

Vaginal dryness is often reported by lactating women.

Women undergoing radiation therapy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma.

Pelvic masses, including ovarian cysts, tumors, and uterine fibroids can cause deep pain.

Is a symptom of interstitial cystitis

For women with interstitial cystitis, pain usually occurs the following day, the result of painful, spasming pelvic floor muscles.

Vulvodynia is a diagnosis in which women experience either generalized or localized vulvar pain most often described as burning without physical evidence of other causes on exam.

Conditions that affect the surface of the vulva including lichen sclerosus et atrophicus, or xerosis

Vaginal dryness is sometimes seen in Sjögren’s syndrome.

Muscular dysfunction: levator ani myalgia may be associated.

Psychologic association such as vaginismus.

In men, a number of physical factors may cause sexual discomfort.

Pain is sometimes experienced in the testicular or glans area of the penis.

Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation.

Men suffering from interstitial cystitis may experience pain at the moment of ejaculation.

Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation.

Urethritis or prostatitis can make genital stimulation painful or uncomfortable.

Anatomic deformities such as exist in Peyronie’s disease, may also result in pain during coitus.

Painful intercourse may be due to the retraction of a too-tight foreskin, tension in a short and slender frenulum, frenulum breve.

Treatment depends on what is causing the pain.

For pain due to yeast or fungal infections,
treating both a yeast infection and associated painful inflammation.

Pain due to post-menopausal vaginal dryness, estrogen treatment can be used.

For endometriosis, medications or surgery are possible options.

The pain, in almost all cases, disappears over time, or at least greatly lessens.

For those who have pain on deep penetration because of pelvic injury or disease, it is recommended to change in coital position to one with less penetration.

Sexual lubricant during intercourse is recommended.

DSM-IV, states that the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginal spasm

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