Dyspareunia: know the causes can help you!

Dyspareunia is the pain that some women experience during sexual intercourses. Loving, making love, have dyspareuniasexual intercourse is good. It also appears that beneficial effects of a good sexual activity are not only psychological, but also physical. Some studies have shown that it can even extend the life span and someone has tried to quantify this “life extension” based on the number of weekly intercourses. The beneficial effect would manifest itself at any age. Unfortunately, this physiological function is not always so pleasant and stimulating.

Sometimes, sexual intercourse can be painful (dyspareunia), thereby creating a reduction in frequency, anxiety, depression, anorgasmy, infertility, couple crisis. This pain felt during a normal sexual activity at Vaginal Introitus, Vagina or Pelvis (abdomen lower part) is called in medical term “Dyspareunia”. It is a problem that often occurs in episodic and lesser form (most women have had at least one episode of this kind); sometimes instead is chronic and can be so intense to require an immediate medical consultation. Between these two extremes lies a wide range of intermediate situations affecting 4-40% of women, according to different estimates that vary according to age, social conditions and cultural level.

Dyspareunia causes:

–      Scars resulting from trauma, lacerations or episiotomies from childbirth, vaginal surgery;

–      Vaginal walls decreased elasticity and dystrophy, age-related alteration of tissue;

–      Bartholin’s glands inflammation;

–      Vaginitis and Vulvitis;

–      Reduced vaginal lubrication;

–      Endometriosis;

–      Pelvic inflammation, adhesions;

–      Ectopic pregnancies;

–      Urinary tract infections;

–      Chronic intestinal diseases;

–      Uterus and ovaries diseases;

–      Psychological alterations;

–      Vaginismus.

Based on pain location, is commonly spoken of superficial dyspareunia when pain is located at Vaginal Introitus and / or at Vagina and deep dyspareunia when pain is localized internally, in the pelvis. The causes are generally distinguished in physical and psychogenic (linked to an organic disease) even if a line between these two groups is not always clear. In superficial Dyspareunia are frequent inflammatory infections of Vulva, Vagina or urinary tract, Hymen anatomical abnormalities, interventions scars, lacerations or episiotomies from childbirth, Vaginismus, vulvovaginal tissues dystrophic changes. In deep Dyspareunia is easier to detect Uterus (fibromatosis, adenomyosis) or ovaries (cysts) diseases, pelvic inflammation, endometriosis, pelvic post-operative adhesions and bowel diseases.

In younger age prevail hymen and vagina anatomic abnormalities, inflammatory and psychogenic causes. As the years go by prevail pelvic diseases, uterine and ovarian patology, vulvovaginal mucous membranes dystrophy, lack of lubrication, childbirths or previous surgeries scars.

If pain is felt during specific sexual positions is difficult whether it is an infectious Vaginal or Vaginal Introitus cause, while it is more likely a pelvic organs disease.

Vaginismus, a condition certainly not rare and most typical of young women, is part of  psychogenic causes. It is characterized by vaginal and  perineal muscles spasm, on an anxious base. This spasm anticipates penetration and can also make it impossible, often it is also accompanied by little or absent lubrication. Sometimes this disorder can be triggered by an inflammatory form. However, I want to focus on some very common forms of Dyspareunia: one linked to vulvovaginal mucous membrane Dystrophy, the other dependent on a lubrication deficit. Dystrophy is typical of menopause and post-menopausal age and is linked but not limited to estrogen deficiency. Probably even age, constitutional and immunological factors are of great importance: the mucous membranes become rigid, thin, inelastic, slightly resistant to trauma, whitish. Against local vaginal Dystrophies have shown a good efficacy use of estrogens, phytoestrogens, moisturizers, lubricants and soothing, vitamin E. Against vulvar dystrophies, vice versa, have found increased use products made from androgens and cortisone. Even here, however, moisturizers and lubricants facilitate the intercourse. Keep in mind that aside from products ready to use such as lubricant gel that usually do not have contraindications and can be used as long as you like, other treatments require several months of application, always use them on prescription and can have contraindications and side effects.

Vaginal lubrication is very important to make sexual intercourse enjoyable. The wet sensation that you experience just before and during sex intercourse depends on the secretion of two small glands located near the vaginal Introit, the Bartholin’s Glands. Inflammatory diseases, deficiency of estrogens and their partial removal may lead to hypofunction. But the most frequent cause is a lack of nerve stimulation: in fact, these glands secrete after nerve impulses resulting in excitement and sexual desire. In absence of this important component their secretion will be low or absent. Unwanted intercourses, with little emotional involvement, occurring without sufficient preparation time (love preambles) are proving in fact more frequently painful. Love preambles become particularly important after the age of 50, as the latency time between excitation and peak of vaginal secretions is progressively stretched. Close correspondence between these secretions and the nervous innervation also explains that lack of lubrication is often intersects with psychological and sexological more complex problems.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.
Filiberto Di Prospero

Filiberto Di Prospero

Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan. 


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