Dyspareunia
The content of the article:
- Kinds
- Causes
- Signs
- Diagnostics
- Treatment
- Possible consequences
- Prevention
Dyspareunia is painful or unpleasant sensations in the genitals that occur before, during, or immediately after intercourse. This disorder of sexual function can occur in both sexes, but men rarely suffer from it.
Accurate statistics on the prevalence of dyspareunia are lacking, as most women with this problem do not seek medical help out of shame. According to a rough estimate of experts, from 15 to 60% of women suffer from manifestations of dyspareunia, but in many of them the disorder is mild and does not require special correction.
Dyspareunia is not an independent disease, but is one of the symptoms of somatic or psychogenic pathology, which can be treated by doctors of various specializations (gynecologists, urologists, andrologists, sex therapists, psychoneurologists).
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Kinds
Depending on the reasons that caused the development of dyspareunia, it is divided into three types:
- psychogenic - sexual dysfunction develops against the background of anxiety disorders, sexual perversions (sexual behavior that does not correspond to the generally accepted norm), phobias, or is a reflection of some unconscious conflict;
- somatic - develops as one of the symptoms of dyshormonal, tumor, traumatic, atrophic, cicatricial, infectious and inflammatory processes of the genitourinary sphere;
- mixed - initially develops against the background of organic pathology, on which psychogenic disorders are further layered, which further enhance the severity of pain.
Psychogenic dyspareunia in women, in turn, is divided into two types:
- intrapersonal - the reasons for the development of sexual dysfunction are associated with previous painful childbirth, trauma, including psychological, traumatic experiences;
- interpersonal - arises as a result of the currently existing psychological conflict between the patient and the sexual partner.
Depending on the time of occurrence, primary (occurs from the very beginning of sexual activity) and secondary (occurs after a certain duration of the period of normal sexual reactions) dyspareunia are distinguished.
If pain is localized in the pelvic region, then this is a deep form of dyspareunia.
If the patient notes discomfort in the area of the entrance to the vagina or external genitalia - superficial.
Causes
The causes of dyspareunia are varied. The superficial somatic form develops under the influence of the following conditions:
- bartholinitis, colpitis (especially atrophic), vulvitis, vulvovaginitis;
- fibrous hymen;
- congenital malformations of the vulva and / or vagina;
- post-radiation or postoperative stenosis of the vaginal opening;
- condylomatous growths in the genitals and perineum;
- vulvodynia (soreness of the vulva not directly related to coitus);
- dystrophy of the vulva;
- Sjogren's syndrome.
Lead to deep dyspareunia:
- varicose veins of the small pelvis;
- retroflection (bend) of the uterus;
- prolapse of the uterus;
- interstitial cystitis;
- inflammatory diseases of the pelvic organs;
- adhesive process in the small pelvis;
- uterine fibroids;
- endometriosis.
Inorganic causes can also provoke dyspareunia:
- an allergic reaction to a condom (to aromas, lubricants, latex);
- the wrong size of the condom;
- means of mechanical contraception (wearing a vaginal ring, diaphragm, cervical cap, spermicidal agents, intrauterine device);
- incorrectly chosen sexual technique (pace and depth of frictions, posture);
- inappropriate behavior of the sexual partner (aggressiveness, coercion to have sex, insufficient preliminary stimulation);
- fear of unwanted pregnancy or sexually transmitted infection.
Psychological reasons leading to the development of dyspareunia are usually associated with the woman's dissatisfaction with the current partner relationship or previous negative experience of sexual activity (rape, gross defloration, inflammation of the genitals).
Signs
Pain or discomfort with dyspareunia can occur at any time during coitus (foreplay, insertion of the penis into the vagina, performing frictions), as well as immediately after it ends. Some women perceive the pain as dull, others as acute, and still others as burning, combined with severe itching. The severity of pain can vary widely, ranging from mild discomfort to unbearable acute pain.
In most cases, pain has a clear localization and dependence on a sexual position or a specific situation. Constantly recurring pains during coitus over time form a woman's fear of sexual intercourse, and she evades it under various pretexts.
With dyspareunia in women, there is no muscle spasm of the vestibule of the vagina, which distinguishes this sexual disorder from vaginismus.
Dyspareunia can occur during intercourse with one partner or with different partners. Often it is combined with anorgasmia, impaired sexual arousal, decreased sex drive.
Diagnostics
The diagnosis is made on the basis of characteristic complaints. To identify the cause of the disorder and differential diagnosis with other diseases, a gynecological, sexological, psychological examination is necessary. As part of a gynecological examination, an ultrasound scan of the pelvic organs is performed, a smear of genital organs is examined for oncocytology, infections.
Treatment
Therapy of the somatic form of dyspareunia is carried out by doctors of the appropriate profile (venereologist, urologist, gynecologist). Medication (local anesthetics, hormone replacement therapy, sedatives, non-steroidal anti-inflammatory drugs, antibiotics) is prescribed depending on the identified etiological factor.
If indicated, dyspareunia is surgically treated (removal of the Bartholin gland cyst, removal of genital warts, dissection of the fibrous hymen, vaginoplasty, correction of anatomical defects of the vagina).
When the vagina and uterus descend, the uterine ring is selected.
Treatment goals for psychogenic dyspareunia are:
- elimination of anticipation of discomfort or pain;
- a change in attitude towards the upcoming coitus;
- achieving harmony in family relationships.
Therapy for psychogenic dyspareunia is carried out by a sex therapist or neuropsychiatrist using the following techniques:
- psychocorrection of a married couple;
- pair and individual psychotherapy;
- sex therapy;
- auto-training;
- body-oriented therapy;
- hypno-suggestive therapy.
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The patient is taught how to relax the muscles of the perineum and vagina. The couple are given advice on the correct choice of sexual technique, the use of lubricants, etc.
Effective elimination of signs of psychogenic dyspareunia is possible only if both sexual partners are interested in the results.
Possible consequences
The consequences of long-term dyspareunia can be a loss of interest in sexual activity, neurosis, depression, divorce.
Prevention
Prevention of dyspareunia includes:
- medical examination of both partners before marriage;
- timely correction of genital anomalies detected during the examination (dissection of vaginal adhesions or stretching of the rigid hymen, performed under local anesthesia);
- familiarization of young people entering into marriage with the anatomical structure and physiology of the reproductive system, the physiological and psychological components of sexual intercourse.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
