Dyspareunia is also known as painful sex or pain during intercourse. According to the DSM-IV the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during or after sexual intercourse that is not caused exclusively by the lack of lubrication or by vaginismus (where a woman’s pelvic floor musculature contracts or spasms involuntarily). Dyspareunia may be primary (lifelong) or secondary (acquired), and it may be generalized (complete) or situational (partial and only in certain circumstances). Pain may be deep or superficial and may be only at the introitus (vaginal opening) or located deep within the pelvis. It might be associated with intercourse and intensified by certain positions and deep thrusting.
Medical evaluation is important to help make an accurate diagnosis of the sexual pain; however psychological factors should also be addressed. Dyspareunia is caused by a variety of medical causes including infections, sexually transmitted diseases, uterine fibroids, endometriosis or changes to the vaginal mucosa/lining including vaginal dryness. Surgical scarring from procedures including anterior and posterior repairs or episiotomy repairs can narrow the introitus (vaginal opening) and lead to increased pain during penetration.
Treatment for painful intercourse is often multifaceted and includes both medical and non-medical interventions. Long lasting moisturizers, water-based lubricants, sexual position changes and increased foreplay may be helpful in certain circumstances. If an infection is present, carefully selected antibiotics may be necessary. Genital pelvic floor therapy may be helpful where muscles are in spasm and vaginal muscles appear tense. Surgical treatment may also be necessary depending on the diagnosis.