Dyspareunia
Pain with Intercourse
While you may experience pain during sexual intercourse occasionally, it is not normal to experience frequent or severe pain.
Pain during sex, or dyspareunia, is the persistent or recurring pain just before, during or after sex.
In addition to the physical pain, couples may suffer from loss of intimacy or experience strain in their relationship.
Dyspareunia is reported to affect 20% of American women and can have negative emotional and psychological effects.
There are different types of dyspareunia
Painful sex may be felt in the vulva or vagina, during or shortly after sex. Many women also report pain in the perineum (the small stretch of skin in between your vagina and anus), pelvis, lower back, bladder, and/or uterus.
Superficial dyspareunia
Pain that occurs prior to or during initial penetration. This pain is felt at the entrance to the vagina during initial penetration.
Entry dyspareunia may result from a variety of conditions
INADEQUATE LUBRICATION
- Lack of lubrication is the most common cause of painful intercourse during initial penetration.
- Inadequate lubrication in younger women is associated with an inhibited arousal phase.
- Although the lack of arousal and difficulty in lubrication initially stemmed from irritation or unsatisfactory sexual techniques, they then become a repetitive and expected component of coitus. These psychologic factors or expectation of pain may now be part of a vicious circle.
TREATMENT:.
The couple with penetration difficulty because of inadequate lubrication will most likely benefit from a variety of water-based products (i.e., Astroglide, Replens) or silicone-based products.
Try different brands until you find one you like.
Vaginal atrophy
Estrogen is a hormone that supports vaginal health by creating thickness to the vaginal tissue which supports normal pH supporting the vaginal environment and creates natural lubrication and elasticity.
Decreases in estrogen production makes the vaginal tissues thinner, which alters the pH and creates a drier, less elastic, and more fragile vaginal canal.
TREATMENT:.
- Lubricants can offer some relief which can be used during intercourse.
- You may be a candidate for estrogen therapy taken orally or intravaginally.
- LASER therapy for vaginal health called FEMILIFT is exclusively offered at our office.
Vulvar disorders
VULVODYNIA and VULVAR VESTIBULITIS -a subcategory of vulvodynia, is a chronic and painful inflammation characterized by a localized area of pain to palpation (point tenderness) or with vaginal penetration.
VULVAR DYSTROPHY – Lichen sclerosis, Squamous hyperlaisia
The etiology is often elusive, as it may be the result of a reaction to chemicals that sets up a cyclic pattern of irritation and tissue response, much like eczema. An infection should be excluded. Common infectious etiologies include Candida, bacterial vaginosis and trichomonas.
If this is the case, please make an appointment to see one of our women’s health care specialists.
Vaginismus
Vaginismus is a condition that causes a woman’s vagina to spasm or squeeze involuntarily when something, or the thought of something, enters the vagina. This causes discomfort or pain.
While this doesn’t stop patients from becoming sexually aroused, the symptoms of vaginismus may cause anxiety about sex, making patients afraid of sex or any kind of vaginal penetration.
Deep dyspareunia
Deep pain usually occurs with deep penetration. It might be worse in certain positions.
Deep dyspareunia may result from a variety of conditions
Fibroids
Fibroids are actually a very common type of growth in your pelvis. Uterine fibroids are a common type of noncancerous tumor that can grow in and on your uterus. Fibroids grow slowly over time and symptoms usually develop slowly.
Approximately 40% to 80% of people have fibroids.
Not all fibroids cause symptoms, and many women don’t realize they have fibroids.
Symptoms can include:
- Excessive or painful bleeding during your period (menstruation).
- Bleeding between your periods.
- A feeling of fullness in your lower abdomen/bloating.
- Frequent urination (this can happen when a fibroid puts pressure on your bladder).
- Pain during sex.
- Low back pain.
- Chronic vaginal discharge.
- Inability to urinate or completely empty your bladder.
- Increased abdominal distention.
Adenomyosis
In this condition, the endometrium starts to grow into the muscular tissue of the uterus. The displaced tissue continues to respond normally to your monthly hormones — thickening, breaking down and bleeding— causing inflammation in the uterus during each menstrual cycle.
This causes the uterus to enlarge which can result in painful, heavy periods.
About 1 in 3 people with adenomyosis don’t have signs or symptoms.
- Painful menstrual cramps (dysmenorrhea).
- Heavy menstrual bleeding (menorrhagia).
- Abnormal menstruation.
- Pelvic pain with or without severe cramping.
- Painful intercourse (dyspareunia).
- Enlarged uterus.
- Bloating or fullness.
Endometriosis
Endometriosis are implants of endometrial tissue found within the peritoneum which is the lining of the pelvis covering the outer surface of the uterus, bladder, and rectum.
The cul-de-sac, which is the space behind the uterus, is the lowest point of the pelvis and one of the most affected areas. Endometriosis can also be implanted on the surface and within the ovaries.
Endometriosis tissue responds to changes in a hormone called estrogen. The implants of endometrial tissue may grow and bleed like the endometrium lining the uterus during the menstrual cycle. When this happens, the blood and tissue shed from the endometriosis implants into the surrounding tissue which becomes irritated, inflamed, and swollen. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.
Retroverted Uterus
A retroverted uterus means your uterus is tilted or tipped backward so it curves toward your spine instead of forward toward your abdomen.
You can be born with a retroverted uterus, or it can develop later in life. Approximately 25% of people have a uterus that tilts backward at their cervix.
Pregnancy is unaffected by a tilted uterus.
There is also no correlation between a retroverted uterus and complications during labor and delivery. In fact, pregnancy will cause your uterus to change to an anteverted position sometime before the second trimester. Your uterus may return to its retroverted position after your baby is born.
One of the main symptoms of a retroverted uterus is painful intercourse. This is because your uterus is positioned differently in your body. Certain positions and deep thrusting may intensify your discomfort. Switching positions may make you feel more comfortable.
Pelvic inflammatory disease (PID) or Pelvic Adhesions
Pelvic inflammatory disease (PID) is the result of an infection of the female reproductive organs.
It most often occurs when sexually transmitted bacteria (chlamydia or gonorrhea) spread from your vagina to your uterus, fallopian tubes or ovaries.
The signs and symptoms of pelvic inflammatory disease might be mild and difficult to recognize. Some women don’t have any signs or symptoms.
When signs and symptoms of PID are present, they most often include:
- Pain — ranging from mild to severe — in your lower abdomen and pelvis
- Unusual or heavy vaginal discharge that may have an unpleasant odor
- Unusual bleeding from the vagina, especially during or after sex, or between periods
- Pain during sex
- Fever, sometimes with chills
- Painful, frequent or difficult urination