Dyspareunia refers to genital pain experienced by a man or woman just before, during or after sexual intercourse. Primary conditions occur from the first sexual experience, whilst secondary dyspareunia develops after previously normal pain-free intercourse. Some dyspareunia occurs only with specific sexual partners.
In an extreme form, vaginismus, the female pelvic floor muscles go into such spasm that penetration is impossible. This may be as a result of previous dyspareunia.
Known risk factors
- Female circumcision
- History of sexual assault
- Peri- or post-menopausal age
- Pelvic inflammatory disease
- Anxiety and depression
A clear description by the patient of the pain makes the diagnosis easier, and a thorough physical examination usually reveals the cause of the pain.
Examination includes the abdomen, pelvic floor and, in women, an internal vaginal examination if possible. In some patients, this may be too painful or stressful, and pre-medication with a sedative may be necessary.
Problems with any part of the urogenital anatomy, or even of the lower abdominal wall, may cause dyspareunia. The commonest causes are:
- Vaginal dryness due to menopause, inadequate lubrication or other reasons;
- Vaginal infection like candida, chlamydia, trichomonas or herpes;
- Urinary tract infections;
- Sexually transmitted diseases;
- Reaction to condom latex;
- Vaginismus as described above: a spasm of pelvic floor muscles;
- Uterine abnormalities like retroversion or prolapse;
- Disorders of the fallopian tubes;
- Hypersensitivity to semen;
- Interstitial cystitis in men or women;
- Prostatitis in men; and
- Sexual abuse or rape.
Known conditions are treated appropriately, for instance hormone replacement, lubricating gels, painkillers and antibiotics where needed. Sex therapy may be needed to learn sexual techniques to minimise dyspareunia. Counselling is helpful in cases of dyspareunia resulting form previous sexual abuse or rape.
(Dr AG Hall)