Love is in the air - or is it? When making love hurts
Sexual intercourse should be a mutually pleasant experience, but some women experience pain instead of pleasure. This is called DYSPAREUNIA and quite simply means painful sexual intercourse. There can be several reasons for this condition, and there are many things that can be done to treat it.
Symptoms
The main symptoms are obviously pain, but the pain can come from either just at the opening of the vagina, or from deep penetration. The pain can be moderate to severe and can be described as burning, stabbing, ripping or tearing type of pain and it can be localized to a small area of the vagina, or just outside of the vagina, or be affecting larger areas or the whole vagina. The pain can be felt during or even after attempted intercourse. Due to the severity of the pain sexual desire is often severely affected. This can cause relationship problems, and further exacerbate the condition.
Causes
There are several reasons why dyspareunia can occur. The pain can be caused by both physical and psychological reactions.
Physical pain at the entrance of the vagina can be caused by lack of lubrication. Changes to the hormonal status of the woman, like in menopause, means a drop in estrogen which results in decreased lubrication. This is a similar case to after childbirth. Lack of foreplay and genital injury can also cause entry pain. Some medicine like antihistamines and antidepressants also cause decreased lubrication.
The condition called vaginismus, which is an involuntary contraction of the pelvic floor, also represents itself as pain at the entrance of the vagina, often resulting in a total impossibility to penetration, even with a tampon. Even gynecological examinations are unsuccessful. Some cancer treatments also cause dyspareunia.
Pain at a deeper level can be caused by the above reasons, but also due to IBS, pelvic organ prolapse, cystitis, endometriosis or fibroids.
Psychological causes include stress, anxiety and depression which all can lead to lack of sexual desire, reduction in lubrication and tightening of the pelvic floor muscles.
Treatment
The exact cause needs to be clarified. A careful history about the issues is taken and a shared treatment objective is set. Your GP may prescribe hormone replacement therapy or a topical estrogen treatment to be applied to the vagina. A specially trained physiotherapist can also help you with a variety of techniques designed to desensitize and relax the pelvic floor muscle and regain your confidence. Receiving the adequate psychological advice is also essential, so speak to a therapist specifically trained in the subject.
