Dyspareunia

Dyspareunia is difficulty or pain experienced by a woman during intercourse.

Causes

Dyspareunia may be caused by a resistant hymen (the membrane that usually covers the opening to the vagina in virgins) or by inflammation of or injury to the vagina, the urethra (the tube that carries urine from the bladder to the outside), the vulva (the structures around the opening to the vagina), or the anus. It can be the result of formation of scar tissue around an episiotomy (a surgical cut to enlarge the opening of the vagina immediately before childbirth) or surgery to repair the vagina.

Other physical causes include tight muscles in the area around the vagina, an "hourglass" contraction of the vagina, a divided vagina, inflammation of the cervix, prolapsed (fallen) uterus, infected fallopian tubes, and endometriosis.

Inadequate lubrication of the vagina is a common cause of dyspareunia. This deficiency may be due to inadequate arousal of the woman before insertion of the penis or to menopause, which is accompanied by a decrease in vaginal secretions and thinning of the vaginal lining. Unconscious tightening of the vaginal muscles, called vaginismus, is another possible cause -- perhaps the result of fear, unreadiness or unwillingness to perform the sex act, or other psychological reasons. Improperly fitted or improperly lubricated birth control devices (condoms or diaphragms) and an allergy to spermicides are other causes.

Symptoms

Pain during or after sexual intercourse is the primary symptom of dyspareunia.

Diagnosis

Diagnosis is made on the basis of both a physical and an emotional evaluation. In some cases, physical abnormalities can be detected during the physical examination. In other cases, careful inquiry into the patient's emotional state and sexual history may reveal factors that account for the discomfort.

Treatment

Treatment for dyspareunia is correction of any underlying disease, injury, or structural defect, if such a problem exists. For some couples, counseling by a psychiatrist or sex therapist may be helpful.

Water-soluble lubricating jelly (not petroleum jelly), obtainable in any drugstore, provides a good vaginal lubricant. Estrogen creams can be used along with water-soluble jelly to restore lubrication to a dry vagina after menopause. Soothing creams and temporary avoidance of intercourse can relieve the soreness of dyspareunia.