Dyspareunia – Painful Sex in Women & Men
What is Dyspareunia?
Dyspareunia can be defined as difficult mating. It is not a well understood condition. This problem can be lifelong or acquired. Dyspareunia usually occurs ten years after the start of sexual activity unless it has always been present. Causes can be an infection, a skin problem, trauma, dryness, male factors, such as prostatitis as well as other physical and psychological factors.
“I hold it true, whate’er befall;
I feel it when I sorrow most;
Tis better to have loved and lost
Than never to have loved at all.”Alfred Lord Tennyson
“Dyspareunia (difficult mating) is defined as genital pain that occurs before, during, or after intercourse. The repeated experience of pain during intercourse can cause marked distress, anxiety, and interpersonal difficulties, leading to anticipation of a negative sexual experience and eventually to sexual avoidance.”American Psychiatric Association, 4th ed. 1994
How Common is Dyspareunia in Women?
“Dyspareunia is one of the most common sexual dysfunctions seen by gynecologists and is estimated to affect about two-thirds of women during their lifetime.”Marinoff, S. C. and Turner, M.L. C., 1993
In 83 percent of the cases studied regarding superficial dyspareunia, the trigger for pain was intercourse and the pain worsened with time. Half of the women reported that they had abstained from a sexual relationship because of the pain.
“Treatment should be started immediately since spontaneous remissions are not expected except for cases where the pain started in the postpartum period.”(Goetsch, M.F., 1991
“Vulvar vestibulitis syndrome (irritation or pain of the vulva) is widely recognized as a major cause of superficial dyspareunia. Superficial dyspareunia from vestibulitis. . .usually appears in young women at the beginning of their sex lives.”The Journal of Reproductive Medicine,“Outcome of Surgical Treatment for Superficial Dyspareunia from Vulvar Vestibulitis,” by David Schneider, M.D., et al, 2001.
The authors conclude:
“The fact that medical professionals are often not aware of this syndrome can cause patients much frustration and misery.”The Journal of Reproductive Medicine, “Outcome of Surgical Treatment for Superficial Dyspareunia from Vulvar Vestibulitis,” by David Schneider, M.D., et al, 2001.
How Common is Dyspareunia in Men?
The medical literature does not quantify the number of men faced with this problem.
Erectile dysfunction, prostatitis-like symptoms, such as perineal, penile, and suprapubic pain (lower abdominal pain above the pelvic bone) during or after ejaculation and voiding (peeing) often cause emotional discomfort in men and is strongly associated with a negative impact on the quality of life.
Dyspareunia can be caused by Prostatitis
Many researchers use the term Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS) according to the National Institute of Health (NIH) classification of chronic prostatitis.
Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS) have clinical symptoms which include:
- ejaculatory pain (dyspareunia or painful sex)
- and discomfort in the area of the perineum or external genitalia.
- dysuria (painful urination)
- frequency (abnormally frequent urination)
- nocturia (urination more than two times during the night)
Dyspareunia Sufferers should Consider the Mind and Body
Dyspareunia can have psychological as well as physical factors. It is important to consider both the mind and the body in any treatment regimen.
“Women with dyspareunia usually discuss the pain with their sexual partner, but fewer than one-half of these women consult a physician. Because dyspareunia is a psychophysiologic condition, both psychologic and physical factors must be considered.”Novak’s Textbook of Gynecology, 12th Edition, by Jonathan S. Berek, 1996
Psychological factors contributing to dyspareunia include:
- Development factors, e.g., an upbringing that invested sex with guilt and shame;
- Traumatic factors, e.g., childhood sexual abuse or other sexual assault;
- Relationship factors, e.g., anger and resentment toward a sexual partner.
Physical Factors Contributing to Dyspareunia in Women – Vaginal Infection
“Vaginal infection is the most common cause of successfully treated dyspareunia.” Glatt, A.E. 1990
Physical Factors Contributing to Dyspareunia in Men – Prostatitis
In men, acute bacterial prostatitis is the most common cause of successfully treated dyspareunia. Other common physical causes are genital glands and adhesive bands that swell only in relation to intercourse.
Acute bacterial prostatitis is when the prostate gland becomes enlarged and tender suddenly. Acute prostatitis is usually caused by the same bacteria that cause urinary tract infections or sexually transmitted diseases.
Hypersensitivity or Irritation of the Clitoris or Prostatitis
Stimulation of the genitalia by sitting, and conditions such as hypersensitivity or irritation of the clitoris in women or discomfort in the perineum or external genitalia as a result of prostatitis in men can be causes of frustrating pain.
Other anatomical causes of dyspareunia in women can be a rigid hymenal ring or scar tissue in an episiotomy scar.
Irritation from Over-the-Counter Products
Dyspareunia can also be caused by irritation from over-the-counter feminine spray products, douches, and contraceptive devices (i.e., condoms, sponges, diaphragms).
Dyspareunia in Women can be Minimized with Water Soluble Lubricants
A common cause of dyspareunia in women is inadequate sexual arousal. This situation can be resolved by counseling the couple to spend more time with foreplay, ensuring that the woman has adequate lubrication prior to intercourse. Use of a water-soluble lubricant is also helpful. When using lubricant, always use water-soluble products, such as KY Jelly or Astroglide.
Dyspareunia can be Associated with Menopause and Lactation
Finally, pain associated with intercourse can be the result of vaginal atrophy from estrogen deficiency in menopausal or lactating women.
This condition can be diagnosed by your physician and can be treated with vaginal or systemic estrogen replacement therapy.
- The Journal of Reproductive Medicine, “Outcome of Surgical Treatment for Superficial Dyspareunia from Vulvar Vestibulitis,” by David Schneider, M.D., et al, 2001.
- Novak’s Textbook of Gynecology, 12th Edition, by Jonathan S. Berek, 1996
- Meares EM. “Prostatitis and related disorders,” Campbell’s urology. 1986:868-85.
- J. Curtis Nickel, MD, FRCSC, Prostatitis Syndromes, “A continuing enigma for the family physician,” Canadian Family Physician, Vol. 37: April 1991