Women may feel pain during intercourse, and it is medically known as Dyspareunia. The pain can occur during or after sex. This issue can be experienced by men as well but is more common in women. Women can feel pain in labia, clitoris, or the vagina. It involves recurring pain within the pelvis or in the genital area where the pain can be intense or sharp.
Dyspareunia is a common problem in women who are going through menopause. A woman can be at an increased risk for this if they take medication that causes vaginal dryness, are post-menopausal or have a bacterial or viral infection.
Women with Dyspareunia feel severe pain or severe tightening of vaginal muscles. Based on the symptoms, this issue can be diagnosed. The doctor needs to examine your medical history and then distinguish the pain. He needs to determine where the pain is occurring, and to do this, he/she may ask you questions about the following:
- The length, duration, and timing of the pain.
- If you had ever had painless sex.
- In case there is enough natural lubrication or you need lubricants.
- If there was any traumatic injury to the genitals.
- Or if you had been sexually abused.
You need to tell the doctor in case you are middle-aged and experience irregular periods, vaginal dryness, or hot flashes. These indicate atrophic vaginitis. If the woman is a new mother and breastfeeding, then too, the doctor needs to know as vaginal dryness is common during this stage.
There may be a medical examination where a woman can be checked for anatomical problems, irritation, or infection. The check-up may involve gently touching the pelvic or genital area to determine the location of pain or inserting a speculum inside the vagina. There could be further tests such as laparoscopy or pelvic ultrasound that is prescribed to make the correct diagnosis.
In order to understand the treatment options for Dyspareunia, it is important to understand what is causing it. Some common causes of Dyspareunia are:
- Skin disorders that can cause burning, cracks, itching or ulcers
- Vaginal dryness caused by breastfeeding, medication, childbirth, no arousal or menopause
- Trauma or injury from an accident, childbirth, pelvic surgery, hysterectomy or episiotomy
- Infections like Urinary Tract Infection (UTI) or yeast infection
- Vulvodynia, which is a pain in the area of the vulva
- Tightening of vaginal wall muscles spontaneously, also known as Vaginismus
- Inflammation of the vagina or Vaginitis
- Uterine fibroids
- Pelvic Inflammatory disease
- Chemotherapy and radiation
- Irritable Bowel Syndrome (IBS)
In some cases, Dyspareunia cannot be stopped, but in some cases, it can be prevented.
- For avoiding infections of the bladder, urinate after sex and wipe from front to back after using the toilet.
- To reduce the risk of yeast infection, try wearing cotton panties, avoid tight clothes, and maintain good hygiene. You must change underwear after sweating, bathe daily, and put on dry clothes soon after swimming.
- Avoid STDs by practicing safe sex, using condoms, or have only one partner at a time.
- In the case of endometriosis, try having sex the week of menstruation or after it, when it is less painful. You can also avoid deep penetration.
- Use lubricants or medication for preventing vaginal dryness. Water-soluble lubricants are a good option.
- Wait for six weeks after childbirth to commence sexual intercourse.
The treatment options for Dyspareunia differ on the basis of the level of pain or the cause. It can range from lifestyle changes, home remedies, medication, therapy, or counseling. Women must discuss with medical professionals to choose the best option.
A medical condition or infection can contribute to the pain, and the right treatment through medicines can resolve the problem. You may need to change the medication that you are already on.
In the case of menopausal women, Dyspareunia can result from inadequate lubrication due to lower estrogen levels. This can be treated with lubricants or medication. The FDA approves the drug ospemifene for women having moderate to extreme Dyspareunia. There might be drawbacks such as hot flashes or risks of blood clots, stroke, or cancer of the endometrium. Another drug is prasterone – a capsule that can be placed in the vagina.
There are over the counter lubricants like Replens, Astroglide or K-Y jelly as well.
For STDs and UTI, you can be given antibiotics, while vaginal yeast infections are treated with antifungal medication. Skin diseases that affect the genital area are treated with steroid creams. In the case of atrophic vaginitis, there is estrogen therapy and can be administered as a pill or vaginal formulation.
Therapies for vulvar vestibulitis include low-dose pain medicines, topical estrogen creams, along with physical therapy that has biofeedback to lessen the muscle tension that occurs in the pelvic floor. There are medicines for endometriosis, or even a surgical procedure may be recommended to remove or control abnormal growth of the uterine tissue.
- For Vaginal Atrophy, several medications are available over the counter and can be used as follows:
- Glycerine-free lubricants that are water-based.
- Water-based lubricants can be applied for 2-3 days.
- Application of topical estrogen directly in the vagina.
- Oral estrogen.
- Estrogen releasing rings that can be put in the vagina to release hormones for change.
- Systematic estrogen therapy includes skin patches, topical gel, pills, or an implant that goes under the skin. Learn more about estrogen therapy in our recommended post: Which Estrogen Therapy is Right For You?
Women must consider that systematic estrogen therapy can have side effects such as stomach pain, indigestion, vaginal bleeding, headaches, nausea, and breast tenderness. The benefits outweigh these risks, but consultation with the doctor is the best way forward.
The women experiencing pain can also try the following to manage the situation.
- Talk about it – talk to your partner about what makes you feel good and what doesn’t. If you need to, then ask him to be patient and slow, so that you are lubricated enough to enjoy the act.
- Don’t rush – A longer time for foreplay can do wonders for a woman’s body. Women may need to be pleasured for a good period of time before they will feel aroused enough for penetration. It differs for each one. So be patient and take as long as it needs.
- Change positions – If a woman feels sharp pain when the partner is thrusting, then a change in position might help. This may not be a long-term solution but can help in some way. The woman on top position can also regulate the depth of penetration without facing too much pain.
- Other – Try taking a warm bath before sex and empty your bladder. Sitz baths are good for painful inflammation, and you can also apply an ice pack to the vulva for relief.
Other treatments For Dyspareunia
There are a few other treatments that women can consider.
- Sex therapy or counseling – A woman may have a negative emotional response to sexual stimulation if they have had an unpleasant sexual experience. If there is an avoidance of sex between a woman and her partner because of the pain, then the communication is lacking. A sex therapist or counselor may be able to help here.
- Desensitization – In a Desensitization therapy, women can learn exercises that relax the vagina and decrease pain.
- Exercise – Kegel exercises are also an option if you want to naturally strengthen the vagina. You need to do it for a week or two, and some effort, along with concentration, is needed. You can do it in sync with breathing exercises as well.
Dyspareunia is experienced by over 75% of sexually active women at some point in their lives. But there are treatment options available based on the underlying cause. So, for example, if the woman has vulvodynia can be treated by a combination of surgery, lidocaine ointment, and amitriptyline.
Lubricants and revision perineoplasty treat postpartum Dyspareunia. In cases of vaginal atrophy which affects around half of the women going through menopause are given estrogen in different forms. Some studies have found that even probiotics may help in certain cases. If you are facing problems with Dyspareunia, then you must contact your physician as soon as possible to get relief and enjoy your life.