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Dyspareunia

(Painful Sexual Intercourse)

Definition

Dyspareunia is recurrent or persistent genital pain experienced just before, during, or after sexual intercourse. Although this condition can occur in both men and women, it is more common in women.

Causes

Women

The cause is believed to be related to physical factors.
Some pain occurs during vaginal entry, but decreases over time. This is often caused by not having enough lubrication because of a lack of sexual arousal and stimulation. It can also be caused by dehydration, or as a side effect of some medications, such as antihistamines. Frequent douching can also cause problems.
Other causes in women include:
The cause of dyspareunia may also be related to psychological factors, although this is less common. Some examples include:
  • Previous sexual trauma, such as 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 usually a response to past sexual trauma or other painful circumstances, but it can also be the result of chronic irritation from a physical cause.

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 may increase your chance of dyspareunia include:
In women:
In men and women, viral or bacterial infections may also increase the chance of dyspareunia.

Symptoms

Pain associated with dyspareunia may:
Female Reproductive System
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Diagnosis

The diagnosis is often made based on your symptoms. A medical and sexual history will be taken. A physical exam will be done.
For women:
For men and women:

Treatment

Women

  • Your doctor may recommend that you use water-soluble lubricants or creams that contain estrogen. Other medications may be prescribed, as well.
  • Infections may be treated with antibiotics or antifungal medication.
  • Inflammation and dermatitis may be treated with topical or injectable corticosteroids.
  • Viral infections like herpes and genital warts will need to be treated.
  • Endometriosis may be treated with medications. In some cases, surgery may be necessary.

Men

To treat prostatitis and urethritis, the doctor may recommend:
  • Antibiotic treatment
  • Sitz baths—soaking the hip and buttocks area in warm water
  • Avoiding alcohol and caffeine, which may be helpful for prostatitis
Sometimes, surgery may be done to treat foreskin and other erectile problems.

Men and Women

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

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

FamilyDoctor.org—American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Sex Information and Education Council of Canada http://www.sieccan.org

Sexuality and U—Society of Obstetricians and Gynaecologists of Canada http://www.sexualityandu.ca

References

American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology. Female sexual dysfunction. Obstet Gynecol. 2011;117(4):996-1007. Reaffirmed 2015.

Female sexual dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 19, 2015. Accessed December 11, 2015.

Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician. 2001;63(8):1535-1544.

Jackson E, Smith MA. Dyspareunia. Essential Evidence Plus website. Available at: http://www.essentialevidenceplus.com. Accessed December 11, 2015.

Lightner DJ. Female sexual dysfunction. Mayo Clin Proc. 2002;77(7):698-702.

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