Dyspareunia (say: "dis-par-oon-ya") is painful sexual intercourse for women. It may be mild or severe enough to restrict the enjoyment of intercourse. Dyspareunia may be associated with physical disorders or, less commonly, with psychologically based sexual dysfunctions.
Occurring almost exclusively in women, this disorder typically occurs in the late 20s and early 30s, a few years after the establishment of a sustained sexual relationship. The prognosis is good if the underlying disorder can be treated successfully.
Physical causes of dyspareunia include an intact hymen; deformities or lesions of the introitus or vagina; retroversion of the uterus; genital, rectal, or pelvic scar tissue; acute or chronic infections of the genitourinary tract; and disorders of the surrounding viscera (including residual effects of pelvic inflammatory disease or disease of the adnexal and broad ligaments).
Among the many other possible physical causes are:
Acute onset of dyspareunia is a classic sign of pelvic inflammatory disease caused by Neisseria gonorrhoeae or Chlamydia trachoma tis.
Psychological causes include fear of pain or injury during intercourse, recollection of a previous painful experience, guilty feelings about sex, fear of pregnancy or of injury to the fetus during pregnancy, anxiety caused by a new sexual partner or technique, and mental or physical fatigue.
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus.
The treatment of physical causes of dyspareunia may include creams and water-soluble jellies for inadequate lubrication, appropriate medications for infections, excision of hymenal scars, and gentle stretching of painful scars at the vaginal opening with a mediumsized Graves speculum. The patient may be advised to change her coital position to reduce pain on deep penetration.
Methods for treating psychologically based dyspareunia vary. Psychotherapy may uncover hidden conflicts that are creating fears concerning intercourse. Sensate focus exercises de-emphasize intercourse itself and teach appropriate foreplay techniques. Information about appropriate methods of contraception can reduce fear of pregnancy; education concerning sexual activity during pregnancy can relieve fears of harming the fetus.
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