What is dyspareunia?
There are various areas that can be painful in cases of dyspareunia: For one thing, the problems can originate at the vaginal opening, the labia majora, the clitoris, the perineum, or even the anus. On the other hand, the internal reproductive organs may also be affected, such as the uterus, the bladder, the ovaries, or the rectum. At first, many women simply feel like their vagina is dry. Then it starts to burn or itch, and it often feels sore whenever it’s touched. Women experience pain when a man penetrates them, or a little later during sexual intercourse. Some people experience this discomfort only during an orgasm. While for some people the pain subsides immediately afterward, for others it persists for days.
Infections can be the cause of such symptoms. However, physical changes are also often the cause. Chronic dyspareunia often occurs in conjunction with an overactive bladder. In many cases, those affected also face significant psychosocial or emotional challenges. Many of them tend to be perfectionists or experienced chronic stress during their childhood. In most cases, a combination of psychological treatment and medication, along with exercise and relaxation techniques, works best. However, affected women need to be patient until their symptoms improve significantly.
Frequency and Age
The prevalence of dyspareunia remains largely unknown. Many women keep their problem to themselves and would rather grit their teeth than seek help. Estimates suggest that between 5 and 20 percent of all women experience pain during sex. Many people believe that these symptoms are “normal” and that they just have to put up with them. Dyspareunia can occur in women of any age, but it is particularly common in very young women.
Dyspareunia: Causes and Risk Factors
Dyspareunia is often linked to cultural factors as well: How is sexuality discussed in a woman’s social circle? What kind of relationship does she have with her body? What expectations does she feel she has to live up to? Past traumatic experiences can be a cause of dyspareunia, just as sexual abuse can be. Depression or burnout can also be linked to pain during sex. Chemotherapy for cancer often causes dryness of the genital mucous membranes. Menopause and breastfeeding, with their hormonal changes, are also usually associated with the vagina becoming less quickly and less thoroughly lubricated during sexual arousal. Many women who suffer from dyspareunia also have a particularly strong fear of pain.
At the same time, however, dyspareunia is often associated with organic problems or infections.
Such infections may include:
Other causes of pain during sex may include:
- Endometriosis
- vaginal dryness, especially after menopause
- Scars from childbirth, such as those caused by an episiotomy
- Weakness of the vaginal wall (especially in older women)
- benign tumors
- Sensitivity to chemical contraceptives or intimate care products
- Vaginismus (vaginal spasms)
- Skin conditions, such as lichen sclerosus or lichen planus
- Excessive muscle tension in the pelvic floor
- sexual dysfunction
- Pelvic Vein Syndrome (Varicose Veins in the Pelvic Area)
Symptoms: Dyspareunia
Either the woman is already in pain when the man tries to penetrate her, Or they may not feel the pain until the penis is already inside the vagina and presses against a specific spot. This pain can range from very mild to so severe that it is almost unbearable. Some women with dyspareunia are also unable to insert tampons, or even the slightest touch causes pain. Some women avoid sports like cycling. The pain may manifest as a burning, stinging, itching, or sore sensation. The symptoms are often similar to those of vaginal candidiasis, which is why the condition is frequently confused with it. In many cases, dyspareunia occurs alongside an overactive bladder—affected individuals have to urinate very frequently.
Dyspareunia: Diagnosis by Us
In a detailed discussion, we try to figure out exactly where the problems lie. We could ask questions like these:
- How long have you been having these problems?
- Was there a specific reason for that?
- Do you always experience pain during sexual intercourse, or only sometimes?
- At exactly what point do they occur?
- What does the pain feel like?
- Do you have any other symptoms, such as bleeding or a strong urge to urinate?
- Do you experience sexual arousal despite the pain?
- Do you have problems with vaginal yeast infections?
- Do you have any other symptoms, such as frequent urinary tract infections, lower abdominal pain, or back pain?
Next, a gynecological examination is performed. The problem here is that, for many of those affected, it is not possible to insert a speculum to examine the vagina. We try to pinpoint exactly which parts of the vulva or vagina are causing pain. We check whether the external (and, if possible, the internal) genitalia show any abnormalities. If possible, we will take a swab of the vaginal discharge to test it for pathogens and fungi. An ultrasound examination of the internal reproductive organs is also useful for identifying or ruling out organic causes. We also monitor muscle tension in the abdomen and buttocks during the examination. If the examination shows that there are no organic causes for the dyspareunia, we usually ask about psychological and social problems or anxieties.
Dyspareunia: Prevention, Early Detection, Prognosis
People who know and like their bodies well have a lower risk of developing dyspareunia. That is why it is important to help girls develop a positive view of their genitalia from the very beginning. It starts with the terms: Only those who have the words for it can come to terms with their own organs. Even adult women often don’t know the difference between the vulva and the vagina. In many families and cultures, everything “down there” is considered a taboo subject. Sometimes, sexuality is passed down among women from one generation to the next as a painful topic. An open conversation can help with this—at school, with a gynecologist, or among friends. Sports, especially dance or belly dancing, can also help you develop a positive relationship with your pelvis.
If you have concerns about your sexuality or have already experienced pain during sexual intercourse, you should talk to your gynecologist about it. Those who address this issue early on have a good chance of achieving a fulfilling and joyful sex life. However, if the pain during sex has been present for some time, women and their partners need to be patient until the condition improves. Women often go through an odyssey of visiting one doctor after another before their condition is correctly diagnosed. Treatment requires effective collaboration among various medical specialties.
Anatomy of the Female Reproductive Organs
From the outside, a woman’s pubic area, or vulva, is visible. It consists of the mons pubis (mound of Venus), the labia majora, and the labia minora. In addition, the vestibule of the vagina and the clitoris are part of the vulva. Inside is the vagina, with the uterus behind it and the fallopian tubes and ovaries located symmetrically on either side. During sexual arousal, glands on the inside of the vaginal opening secrete a fluid that lubricates the vagina. As a result, the penis can glide more easily into the vagina during sexual intercourse. On the other hand, the secretion contains glucose, which provides energy to the sperm as they make their way to the egg.