Dyspareunia: causes, symptoms and treatment

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Dyspareunia is a sexual disorder whose main characteristic is persistent genital pain before or during penetration, being able to diagnose both women and men.

Despite being able to occur in both sexes, it is more common in women, with women with menopause or who have recently given birth showing more risk. The causes can be multiple, both physical, related above all to a lack of estrogen and a lack of lubrication; as psychological, linked to fear, anxiety or bad sexual experiences.

The chosen treatment will depend on the cause of the dyspareunia, being important to inform and educate the patient about sexual intercourse, about the different phases and the importance of lubrication, as well as integrating the couple in therapy since it is essential that they also know the problem and how to proceed to correctly deal with the situation.

In this article we will talk about dyspareunia, we will know what its main characteristics are, what causes are linked to this affectation, what symptoms it presents and what are the treatments that can be applied.

  • We recommend you read: “The 10 most common sexual dysfunctions (and how to treat them)”

What is dyspareunia?

Dyspareunia is a sexual dysfunction classified within pain disorders. The main characteristic of this condition is pain in the genitals that occurs repeatedly or continuously during sexual intercourse, although it can also occur before or after penetration.

This pain can occur in both women and men, despite being much more frequent in the female population, close to 15% of adult women show it.

  • We recommend you read: “Vaginismus: causes, symptoms and treatment”
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Causes of dyspareunia

As with other sexual dysfunctions, the causes that are related to dyspareunia They can be both organic and psychological, the latter being the most frequent.. Regarding the organic causes in women, we can observe affections or deformations in some of the parts of the female reproductive organ such as the vagina, the uterus, the fallopian tubes or the ovaries; infections in the vagina or clitoris; affections in the urethra or in the anus; scars or diseases in the pelvis.

Dyspareunia can also be caused by pathologies not linked to the sexual organs such as diabetes, autism, chemotherapy treatment, estrogen deficiency problems, which are hormones mainly related to the female sex, or a decrease in vaginal lubrication, thus making penetration difficult. . This reduction may be due to the consumption of some medications or some type of drug such as cannabis.

Similarly, we must monitor what intimate hygiene products we use or the type of condoms or contraceptive methods, such as the IUD or spermicides, which do not irritate or reduce lubrication, increasing the possibility of pain upon penetration. In men, the organic aetiology most closely related to this type of dysfunction is infection of the urethra, seminal vesicles, prostate glands, or urinary bladder.

On the other hand, the psychological causes that can lead to dyspareunia in both women and men They are mainly linked to poor or inadequate sex education, anxiety problems, fear of sexual intercourse, penetration or having had bad sexual experiences in the past. In women, insufficient sexual arousal can also be observed, related to less lubrication, which can lead to pain on penetration.

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Epidemiology

As we have already mentioned, this disorder can occur in both women and men, although it is more frequent in the female sex. observed in approximately 15% of adult women. It can appear at any age from the beginning of sexual intercourse, with a higher risk being perceived in women in the menopausal phase, since the decrease in estrogen that this period entails leads to greater dryness, lack of lubrication and greater sensitivity of the vaginal area. .

Also related to hormonal change and increased sensitivity, there is an increased risk of developing dyspareunia during postpartum or breastfeeding. This sexual disorder usually occurs together with vaginismus, which consists of the involuntary contraction and tension of the muscles surrounding the vagina. Such is the comorbidity of these pathologies that the fifth edition of the Diagnostic Manual of American Psychiatrists (DSM 5) classifies them together under the name of genitopelvic pain/penetration disorder.

Likewise, a differential diagnosis should be made with: medical alterations that explain the pain, we will treat these alterations and we will not consider that the subject has a sexual disorder; substance with side effects that make it difficult or painful during sexual intercourse; another type of mental disorder such as a disorder due to somatic symptoms, where we can also observe sexual symptoms; or punctual pain during sexual intercourse, that is, if we have felt pain on some occasions and this fact does not cause us discomfort or is not dysfunctional, it will not be considered a disorder.

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Symptoms

The main and characteristic symptom of dyspareunia is genital pain that appears repeatedly during intercourse.. In women, the pain can be felt superficially during penetration or deeper during movements that occur during sexual intercourse. The intensity of the pain can also be variable, noticing a slight discomfort until feeling a high pain.

In any case, to be considered a disorder, it must generate discomfort in the subject who presents it or alterations in interpersonal relationships. In other words, as it is a disorder that appears during sexual intercourse, having repercussions and making it difficult for them to end satisfactorily, it is very likely that the couple will be affected.

as we advance DSM 5 lists dyspareunia and vaginismus under the same heading Genitopelvic Pain/Penetration Disorder. The main criterion to be met is the presence of persistent and recurrent difficulty in one of the following symptoms: marked vulvovaginal or pelvic pain during sexual intercourse or penetration attempts; intense fear or anxiety in anticipation of the pain that vaginal penetration may bring; or a marked tension or tendency to tighten the pelvic floor muscles before or during penetration (symptoms related to vaginismus).

In the same way, the affectation must last for a minimum of 6 months, in this way, we rule out that they are punctual pains (which may be normal) and cause clinically significant discomfort in the individual. When we make the diagnosis, DSM 5 also allows us to specify if the disorder is lifelong, that is, it has always been present, in all sexual relations or acquired, if it has had periods without showing the disorder or the current severity of the affectation from mild , moderate or severe.

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Treatment

When we consider what is the best mode of intervention for dyspareunia It is necessary first to know what the cause is. that causes the alteration since this will make it more likely that the treatment will be effective. There are different methods of intervention depending on the affectation generated by the problem, even so, there is currently no treatment that is considered effective in the treatment guide for disorders.

If the causes are organic, the treatments that are usually used are: the doctor, where the use of moisturizers, lubricants, rose hips, etc., is usually prescribed, which help reduce friction and dryness and increase lubrication. It can also be treated with hyaluronic acid, both in cream and injected, or with estrogens, which, as we have already said, a deficit of this hormone can lead to dyspareunia. It is important that estrogen treatment is followed regularly, otherwise the desired effects will not be achieved.

Likewise, other medical treatments such as hormone therapy have been tried, for women with symptoms of early menopause or low estrogen levels; or as estrogen receptor modulators, which is the intervention with fewer side effects, achieving a decrease in atrophy and an improvement in bone mass.

Other interventions performed at a physical level are the Co2 laser that with the production of heat helps to rejuvenate the vaginal tissue, thanks to the production of collagen and surgery, in order to recover the tone and tension of the vaginal muscles. .

In reference to psychological treatments, it has been seen to be useful, as a preventive intervention, carry out a good sexual educationinforming about the different phases of the sexual relationship, about the importance of a good lubrication, the knowledge will help the subjects to reduce the fear and anxiety related to sex and to know more about their own body.

On the other hand, in the psychological intervention carried out with patients who already show the pathology, it will be important that the couple also participate so that both are informed and know about the situation, understand what is happening and how it is appropriate to proceed.

A regular sexual activity will be prescribed so that the patient can face his fears, gradually, that is, it is not necessary for penetration to occur but we will gradually stimulate, get the couple to enjoy or enjoy sex again. In this way, it will be easier to lose fear and progress.

Finally, we can also treat negative thoughts or emotions related to intercourse. The application of cognitive behavioral therapy with the purpose of modifying dysfunctional thoughts and behaviors that do not help to achieve a satisfactory relationship can be useful.

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