Painful sexual intercourse is a medical condition called dyspareunia which may be caused by medical or psychological causes. The symptom is significantly more common in women than in men, affecting up to one-fifth of women at some point in their lives. Types Superficial Deep Causes Numerous medical causes of dyspareunia exist Congenital · endometriosis · vaginal septa · thickened undialatable hymen · hypoplasia of the introitus · ovarian cysts can cause deep pain Acquired · infections (candidiasis, chlamydia, trichomoniasis, urinary tract infections, pelvic inflammatory disease) · vulvar vestibulitis · tumors like uterine fibroids can cause deep pain · xerosis (dryness, especially after the menopause) · interstitial cystitis · uterine prolapse · LSEA (lichen sclerosus et atrophicus) · Surgical complications, including female genital mutilation, when the introitus has become too small for normal penetration (often worsened by scarring) Causes that can be either acquired or congenital · retroverted uterus · vaginismus Physical causes: Estrogen deficiency is a particularly common cause of sexual pain complaints related to vaginal atrophy among postmenopausal women and may be a result of similar changes in menstruating women on hormonal birth control. Vaginal dryness is often reported by lactating women as well. Women undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma. Vaginal dryness is sometimes seen in Sjögren's syndrome, an autoimmune disorder which characteristically attacks the exocrine glands that produce saliva and tears. Physical causes in men · . Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. · 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 intense 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 of the penis Symptoms · Pain only at penetration (entry) · Pain with every penetration, even while putting in a tampon · Pain with certain partners or just under certain circumstances · New pain after previously pain-free intercourse · Deep pain during thrusting, which is often described as "something being bumped" · Burning pain or aching pain Treatment Treatment depends on the cause of dyspareunia: · If vaginal dryness is the problem, you can ease penetration and intercourse with increased clitoral stimulation before intercourse or lubrication with an over-the-counter lubricant such as K-Y jelly, Replens or Astroglide. · For vaginal yeast infections, you will be given antifungal medication. · Antibiotics will be prescribed for urinary tract infections or STDs. · To relieve painful inflammation, try sitz baths, which are warm-water baths in a sitting position. · For skin diseases affecting the vaginal area, the treatment will vary depending on the disease. For example, lichen sclerosus and lichen planus often improve with steroid creams. · For vulvar vestibulitis, typical therapies include topical estrogen cream, low-dose pain medications, and physical therapy with biofeedback to lower the muscle tension in the pelvic floor. · For atrophic vaginitis, estrogen therapy will be prescribed, either as a vaginal formulation or as a pill. · If endometriosis is causing your dyspareunia, you may be prescribed medication or you may need surgical procedures to control or remove abnormal growths of uterine tissue. · For dyspareunia that has no apparent physical cause or has lasted for months or years, you may need psychological counseling to address stress or anxiety regarding intercourse. Prevention Although some causes of dyspareunia, such as a history of abuse or trauma, can't be avoided, other causes can be prevented: · To decrease your risk of yeast infection, avoid tight clothing, wear cotton underpants and practice good hygiene. Change your underclothes after prolonged sweating. Bathe or shower daily, and change into dry clothing promptly after swimming. · To avoid bladder infections, wipe from front to back after using the toilet, and urinate after intercourse. · To avoid STDs , practice safe sex by maintaining a relationship with just one person, or using condoms. · To prevent vaginal dryness, use a lubricant, or seek treatment if the dryness is due to atrophic vaginitis. · If you have endometriosis, avoid very deep penetration, or have sex during the week or two after menstruation (before ovulation), when the condition tends to be less painful.
