Pain During or After Sexual Intercourse

 Pain, during or after sexual intercourse, is termed as dyspareunia in medical parlance. It is defined as pain in the genital region which appears just before, during or after intercourse and is recurrent in nature.

 

Causes of Dyspareunia

Dyspareunia can occur both due to physical and emotional causes. Let us first look at the physical causes that may lead to pain during or after intercourse.

• Inadequate Lubrication: One of the commonest causes of dyspareunia is inadequate lubrication. It may be a result of chronic alcoholism or a side effect of medicines like antidepressants, antihistamines, sedatives, anti-hypertensive medicines or birth control pills. Insufficient lubrication is also seen as a result of decreased estrogen levels after childbirth, during lactation or after menopause.
• Vaginismus: This is a condition observed in some women where the muscles lining the vaginal wall go into involuntary spasms.
• Infection: Any infection of the genital or urinary tract may lead to pain during penetration.
• Congenital Anomalies: Deformities of the genital tract present since birth, like vaginal agenesis and retroverted uterus may lead to dyspareunia.
• Certain Diseases: Some diseases like endometriosis, cystitis, irritable bowel syndrome and pelvic inflammatory disease may lead to pain during intercourse.
• Certain Treatments and Surgeries: Women who have undergone surgeries like hysterectomy or a blotched episiotomy, or have taken treatment for cancer in the form of chemotherapy or radiation therapy may complain of pain during intercourse.

Let us now look at some of the emotional causes that may lead to painful intercourse:

• Emotional Stress: This is one of the primary reasons for dyspareunia. Stress may lead to involuntary tightening of the muscles of the pelvic floor while making love, a condition known as vaginismus. This may lead to pain during the sexual act.
• PsychologicalFactors: Factors like low self-esteem, anxiety, fear of commitment or marital problems may be a cause for pain during intercourse.
• Sexual Abuse: Victims of sexual abuse often face difficulties in leading a normal conjugal life. They may complain of pain during intercourse.

 

Investigations Required

To establish a diagnosis of dyspareunia, your doctor would like to know your complete medical history including history of any previous illness, surgery, prolonged medical treatment or history of sexual abuse. The doctor would like to assess your emotional well-being and the position in which you generally experience pain during intercourse. He would like to do a pelvic examination to rule out any congenital anomaly, infection of the genital or urinary tract or any other related condition. Sometimes, an ultrasound of the pelvic region may also be required.

 

Treatment of Dyspareunia

Treatment of dyspareunia includes medication as well as counseling.

Medication: In case the doctor feels that the pain during intercourse is because of insufficient lubrication, he may prescribe medicines for systemic or topical use to increase lubrication. Ospemifene is one such medicine which has been approved by the Food and Drug Administration (FDA) to increase vaginal lubrication in women who complain of severe dyspareunia. In case of post-menopausal women, topical estrogen may be prescribed. If a patient is taking some medicines which lead to decreased lubrication, these medicines may be changed.

Counseling: Counseling plays an important role in overcoming dyspareunia. Couples who have begun to avoid sexual intimacy because of pain can be helped by a sex therapist. Similarly, counselors can help patients with issues like low self-esteem or anxiety.

Relaxation Techniques: Patients are taught techniques to relax in order to remove the fear of pain during intercourse. Kegel exercises are useful in women suffering from vaginismus. These exercises help in strengthening the muscles of the pelvic floor.

Changing Positions: Couples may be guided to switch their positions during intercourse. It is possible that the pain during intercourse is because of too much stress on the pelvic floor muscles in a particular position. Changing the positions may be beneficial in such cases.

Better Understanding With the Partner: Better communication and understanding with the partner can go a long way in soothing frayed nerves and help in reducing the pain during intercourse.

 

Reference:

• ‘Evaluation and Differential Diagnosis of Dyspareunia,’ by Lori J Heim. Published in the April 2001 issue of the journal American Family Physician, accessed on Mar 14, 2015. Retrieved from: http://www.aafp.org/afp/2001/0415/p1535.html