By Dr. Kemi Ailoje
Have you tried to be intimate with your partner and you realized you could not because you could not bear the pain or have you ever felt pains hours after sexual intercourse? Are you currently having issues in your relationship because of this intolerable pain? This kind of pain is what is medically known as dyspareunia.
WHAT IS DYSPAREUNIA?
Dyspareunia refers to persistent or recurrent pain (mild or severe) at the vaginal opening or deep in the pelvisthat may occur just before, during or after sexual intercourse. Dyspareunia is not a condition limited to women alone but studies have shown it to be prevalent amongst women than in men.
CAUSES OF DYSPAREUNIA
Painful intercourse can have causes that are not due to underlying disease. Examples include inadequate lubrication, rough sex, trauma or negative feelings about a partner.
It is important to understand the duration, location and nature of pain caused by dyspareunia to identify the cause. Dyspareunia can be caused by many factors which could be physical (entry/deep), psychological or both.
PHYSICAL CAUSE OF DYSPAREUNIA (Entry)
Entry pain may be caused by vaginal dryness, vaginismus, size disparity, genital injury, inflammation/infection, skin disorders/irritation, (or) abnormalities at birth.
• Vaginal dryness: Medications such as hormonal birth control, antidepressants, antihistamine could lead to vaginal dryness. The hormone estrogen helps in the secretion of fluid that serves as lubricant during sexual intercourse. When there is decrease in the level of estrogen like in menopausal women, the lubrication available is low thereby leading to vaginal dryness.
• Vaginismus: vaginismus is the involuntary contraction around the pelvis wall that occurs whenever there is an entry into the vagina such as penis, tampons, speculum during gynaecological examination,
• Size Disparity: This is when the erect penis is too large for the vaginal entrance. It can cause tearing in the vagina and lead to pains during and after sexual intercourse.
• Genital Injury: Is a form of injury to the genital area either in a man or a woman, such injury could cause a permanent or temporary damage to the urethra, bladder and the reproductive organs.
• Inflammation/Infection:Dyspareunia can also be caused by inflammation around the vulva or byinfections such as Urinary Tract Infection, Sexually Transmitted Diseases and yeast infections in the vagina.
• Skin disorder/Irritation: Skin disorders or conditions such as eczema, lichen, ringworm, around the genital area when bruised can also cause pain at entry. Skin irritation from chemicals can also cause bruises around the genital area thereby causing dyspareunia.
• Abnormalities at Birth: Dyspareunia is often caused by the lack of a properly formed vagina (vaginal agenesis), or by the presence of a membrane covering the vaginal opening a condition medically referred to as imperforate hymen.
PHYSICAL CAUSE OF DYSPAREUNIA (Deep)
Physical cause of dyspareunia leading to deep pain during penetration may be caused by surgeries or medical treatment such as cancer treatment, or certain medical conditions and illness including:
• Endometriosis: A disease where the tissue that surrounds the uterus (endometrium) extend beyond the uterus.
• Pelvic Inflammatory Diseases: An infection of the female reproductive organ which causes it to swell.
• Uterine prolapse: The stretch and weakening of the pelvic floor muscle or ligament resulting in inadequacy to provide enough support for the uterus (womb).
• Uterine Fibroids: They are non-cancerous growth found in the uterus (womb).
• Cystitis: it is the inflammation of the bladder mostly caused by Urinary Tract Infection (UTI).
• Irritable Bowel Syndrome: A disorder that causes pain in the large intestine.
• Adenomyosis: A condition in which the endo-lining (inner lining of womb) grows within the womb.
• Hemorrhoids: Haemorrhoids otherwise called piles are swollen veins that are positioned in the rectum (internal hemorrhoids) or anus (external hemorrhoids) which can cause itching, irritation and bleeding.
• Ovarian Cysts: Ovarian cysts are fluid filled sac that does not contain an egg in contrast to follicles which contains egg. Ovarian cyst usually go away on its own within few months but can also cause pain, discomfort, abdominal pain, fever, vomiting and even dyspareunia.
• Adhesion: collections of scar tissues sometimes results in pain during intercourse.
• Retroverted uterus: Occurs when the uterus is positioned backward towards the rectum (the final section of the large intestine terminating at the anus) rather than forward towards the stomach.
PSYCHOLOGICAL CAUSE OF DYSPAREUNIA
Psychological factors that could cause dyspareunia are: guilt, fear, history of rape or sexual assault, anxiety, depression, stress, low self-esteem, lack of communication between partners, poor body image, etc.
A Person could be faced with the issue of painful sex which can be dreadful thereby resulting into relationship and marital challenges.
SIGNS AND SYMPTOMS OF DYSPAREUNIA
• Stabbing pain similar to menstrual cramps during or after intercourse
• Pain with every penetration even with the use of lubricant
• Burning, itching or aching during or after sexual intercourse
• Pain after hours of sexual intercourse
EFFECT OF DYSPAREUNIA
• Relationship/Marital issues
• Mood swings
• Low self- esteem
• Loss of libido
• Infertility
………………….To be continued next week
