Definition

Dyspareunia refers to pain in the pelvic area. It occurs during or after sexual intercourse. This can occur in both men and women. It is more common in women.

Causes

Women

The cause is believed to be physical factors at least 75%-80% of the time.

Some pain occurs first at entry but decreases over time. This is often caused by not having enough lubrication. This is often due to a lack of sexual arousal and stimulation. It can also be due to some medications. Antihistamines can cause dryness. Frequent douching can cause problems as well.

Other causes in women include:

Psychological factors are not often involved, but may be associated with:

  • Previous sexual trauma (rape or abuse)
  • Feelings of guilt
  • Negative attitudes toward sex
These factors may lead to a condition called vaginismus . This is painful and involuntary contractions of vaginal muscles. It is linked to fear of vaginal penetration.

Men

The most common causes of pain in men are:

Pain occurs at the time of ejaculation.

Pain that occurs while obtaining an erection may be associated with:

  • Inflammation of the foreskin
  • Loss of elasticity of the foreskin
  • Trauma to the penis
  • Herpes or genital warts
  • Local allergies or irritations
  • Curvature of the penis caused by Peyronie's disease

Risk Factors

Factors that increase your chance of dyspareunia include:

In women:

  • Being postmenopausal
  • Taking medications that produce a vaginal dryness

In men and women:

  • Viral or bacterial infections

Symptoms

Pain associated with dyspareunia may:

  • Occur during or after sex
  • Be itching, burning, stabbing, or aching
  • Be located in the:
    • Vagina
    • Urethra
    • Bladder
    • Pelvis
    • Penis
    • Testicles
  • Occur during all phases of sexual contact or only with deep thrusting
  • May also occur with tampon use—fabric absorbs natural vaginal lubricant

Female Reproductive System

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Diagnosis

The diagnosis is often made based on your symptoms. Your doctor will take a medical and sexual history. A physical exam will be done.

For women:

  • Your doctor will check your vaginal wall to look for:
    • Signs of dryness
    • Inflammation
    • Infection
    • Genital warts
    • Scarring
  • Your doctor will also perform an internal pelvic exam to look for:
    • Abnormal pelvic masses
    • Tenderness
    • Signs of endometriosis

For men and women:

  • Your doctor may suggest more tests. They may include cultures to find infections. Imaging studies like ultrasound may also be used.
  • You may be referred to a counselor. This will help to determine whether psychological issues may be a cause.

Treatment

Women

  • Women may use lubricants . They may also use creams with that have estrogen. Some medications may also be given by your doctor.
  • Infections may be treated with antibiotics or antifungal medicine.
  • Viral infections like herpes and genital warts will also need to be treated.
  • Endometriosis may be treated with medications. In some cases, surgery may be done.

Men

To treat prostatitis and urethritis, the doctor may recommend:

  • Antibiotic treatment
  • Sitz baths
  • Avoiding alcohol and caffeine—may be helpful for prostatitis

Sometimes surgery may be done to treat foreskin and other erectile problems.

When no physical cause of the pain can be found, sex therapy may be helpful. Some concerns need to be worked through in counseling. These may include:

  • Guilt
  • Inner conflict
  • Unresolved feelings about past abuse
  • Need for self-punishment

Prevention

  • After birth, gentleness and patience should be used. Wait at least six weeks before sexual relations.
  • Good hygiene and routine medical care can help.
  • Safe sex will reduce the risk of STDs.
  • Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
  • The use of a water-soluble lubricants like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant. It is not water soluble. This may encourage vaginal infections.