Dyspareunia (Painful Sex)
Dyspareunia is a pathology that manifests itself with the feelings of pain, hurts and aches, during sexual intercourse, at the vaginal entrance or at the groin area. In medical terminology it is named as “Dyspareunia (painful intercourse, painful penetration)”.
Many women start to feel pain with their first sexual intercourse (Primary Dyspareunia), others encounter this problem after a period of normal sexual life (Secondary Dyspareunia).
Couples, who encounter the problem of painful intercourse, first of all must apply to a specialist gynecologist and get a full gynecological examination, because many of the problems that cause dyspareunia are gynecological diseases and the definite cause of dyspareunia can only be diagnosed by an experienced gynecologist after a gynecological examination.
If there is not an underlying gynecological problem, then psychological causes must be considered. With many women who have partially overcome the vaginismus problem there are feelings of pain and aches during sexual intercourse resulting from the vaginal contractions that have not completely ceased. In such cases, treatment methods are completely different.
According to the location of the pain, dyspareunia is categorized into two as superficial and deep dyspareunia. Differentiating these two types of pain is important for the diagnosis.
It is the perception of the pain at the outer part of the vagina during the penetration of the penis.
Vulvar Vestibulitis Syndrome (VVS): It is a condition that manifests itself with rashes and pain at the point between vulva and the vagina right besides the hymen (maidenhead). People who suffer from VVS complain from extreme pain during sexual intercourse with their partners. Its treatment consists of the surgical removal of this area.
Vaginitis: It is the generic name for all vaginal inflammations. Among the most frequently encountered causes of vaginitis are fungal infections (especially Candida albicans, Candida Glabrata), Trichomanas and other parasitic infections, and Gardnerella infections (synonyms are Gardnerella vaginitis, non-specific vaginitis, Bacterial vaginosis).
Vulvitis: The outer genital area in women is called the “vulva”. The microbial (infectious) and non-microbial (inflammatory) problems of the vulva are called vulvitis and in these cases there may be pain during sexual intercourse.
Among the infected conditions of the vulva are candida vulvitis (fungal infections), herpes type 2, and HPV (genital wart).
Among the non-infectious pathologies of the vulva are lichen sclerosus, psoriasis and eczemas. Lichen sclerosus is an inflammatory disease which manifests itself through atrophy on the outer genital area.
Narrowness of the vaginal entrance: As a result of various birth or hormonal reasons, the vagina and the vulva may be smaller than normal; in that case the intercourse may be painful too.
Vaginal Dryness: With women, in the excessive secretion of the prolactin hormone from the pituitary gland (hyperprolactinemia) and during the breast feeding periods after birth, due to the decrease in vaginal wetness, sexual intercourse may become problematic. As a result of sexual reluctance, depression and individual constitutional features and together with the low amount of secretion of the secretions which sustain the wetness of the vagina, superficial dyspareunia may be encountered.
Menopause: During menopause, due to the lack in the estrogen hormone, which sustains the solidity and wetness of the vagina epithelium, there is complaint of dyspareunia. This problem can be cured easily by menopausal hormone treatment. To give estrogen hormone to the women who are in the after menopause period increases the blood flow in the vagina and the clitoris.
The other sexual complaints that are encountered due to menopause and aging are the loss of sexual desire, painful sexual intercourse, decrease in sexual response, hardship in achieving orgasm (anorgasmia) and decrease in genital sensitivity. Moreover, decreases in the testosterone level in the periods after menopause cause decreases in sexual stimulation, libido and orgasm.
Surgical operations: After operations such as, vaginal narrowing, vaginal hysterectomy (removing of the uterus from below), operations done in cases where the urine bladder prolapses (colporraphy) and the rectum (last section of the intestines) prolapses, dyspareunia can be encountered.
Normal Birth: The incisions (episiotomy) made during normal birth giving, in order to enable the head of the baby to protrude easily, if not mended properly, could cause problems during sexual intercourse in the future.
Having a thicker than normal hymen (rigid hymen): In cases where the hymen is thicker and higher edged than normal, sexual intercourse may also be painful.
Deep dyspareunia is the experiencing of pain in the lower groin and abdomen areas after the full insertion of the penis into the vagina. Diseases related to the uterus, ovaries, tubes and lower abdomen area may cause deep dyspareunia. These are:
Endometriosis: It is the disease when the tissue called the endometrium is found outside the uterus in the abdomen area. Endometriosis is a disease that may cause problems such as, feeling pain during sexual intercourse, painful menstruation (dysmenorrhea) and infertility (not being able to conceive). Its definite diagnosis is made by laparoscopy.
Cystitis: It is the inflammation of the bladder. Symptoms such as, to urinate frequently and painfully, to feel burning sensations and piercing pain when urinating, and to feel pain during sexual intercourse go along with the definition of cystitis.
Myoma: Myoma that generate in the muscle tissue of the uterus according to their sizes and locations may cause pain during sexual intercourse.
Ovary Cysts: Cysts stemming from the ovaries, due to the traumas during the sexual intercourse, may cause pains in the groin area.
Pelvic Inflammatory Disease (PID): In cases such as, inflammation of the endometrium (endometriosis), inflammation of the fallopian tubes (salpingitis, adnexitis) or inflammation of the ovaries (oophoritis) sexual intercourse is also painful. The generic name for all of these infections is PID (Pelvic inflammatory disease). With a simple gynecological examination and laboratory tests, definitive diagnosis can be made.
Psychogenic Based Dyspareunia
The cause of dyspareunia in the patients, who are not diagnosed with any organic cause and everything seems normal in their medical examinations, is psychological and this problem concerns more the psychological conditions that affect the subconscious of the woman. Vaginismus, the involuntary contraction of the vaginal muscles, is the most frequently encountered reason for dyspareunia.
Other frequently observed causes of psychogenic based dyspareunia:
- The fear of getting pregnant
- The fear of hurting the baby during pregnancy
- Insufficient foreplay
- Lack of sexual experience and information
- Pre-lived sexual traumas (abuse or rape etc.)
- Being reluctant towards the partner.
Treatment in Dyspareunia
A patient, who has been diagnosed with dyspareunia, while having sexual intercourse with her partner for months or for years, might be experiencing displeasing feelings such as pain, ache and piercing pain. Following the definite diagnosis after a gynecological examination, treatment starts.
During sexual intercourse, if pain generates as a result of psychogenic based contractions, in the treatment, psychological therapy methods are initiated. However, in many dyspareunia cases, there are only some organic based conditions and in these conditions, through certain simple surgical processes, a full treatment can be achieved.
Surgical Methods in the Treatment
Vulvar Vestibulitis Syndrome (VVS) is usually seen in women who suffer from dyspareunia in the first periods of their marriages and its treatment consists of the removal of this pain sensitive area. For this, first of all, the pain sensitive areas are determined through certain tests with the help of a “cotton tipped stick”.
Afterwards, the problem of having pain during sexual intercourse will be completely eliminated through local anesthesia (local sedation) and the removal of this area or widening the vaginal entrance a bit. In medical terminology, this operation is called “vulvar vestibulectomy”.
In a similar manner, if the area that is cut (episiotomy) and stitched in normal birth giving is not healed properly, then its aesthetic appearance may be bad and moreover, the stitches may even cause pain during sexual intercourse. In this case, the removal of these tissues by vaginal aesthetic operations yields successful results both aesthetically and functionally.
Again, also as sexual intercourse may be painful in the case where the hymen is thicker and higher edged than normal, this condition can be mended by a simple surgical operation that would only last about 10-15 minutes. This surgical procedure is named partial hymenotomy.