Pain During sex / Dyspareunia

Painful IntercourseYou really love your husband. But when it comes to having sex, you are horrified. It is damn painful.
You feel embarrassed or scared to discuss this issue of pain during intercourse with anyone else. You might be experiencing some vaginal dryness (common during menopause), that results in painful intercourse.

In whatever way you put it, it’s not fun… and it can lead to problems in your relationship if not addressed.
The truth is that sex isn’t pleasurable or pain-free for all women all the time. In fact, many women experience painful intercourse at some point in their lives, for a variety of very normal reasons. The medical term for painful intercourse is dyspareunia.

Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse and that causes you personal distress. And painful intercourse is worth talking about, because there are treatments that can help eliminate or reduce this common problem. The condition can occur both males and females. But it is relatively rare in males.

Causes of Painful Intercourse

There are many causes, and depending on the type of pain you’re experiencing (during penetration or deep pain, for example), the cause can vary.

1. Most common is inadequate lubrication. As your partner for a bit more foreplay, which can easily resolve this problem.
2. This can be caused by a drop in estrogen during menopause, after childbirth, or during breast-feeding.
3. You may have also had an injury or surgery that is causing the problem. Inflammation or infection are also causes.
4. Maybe you’re having a reaction to your birth control product. This is definitely something we can discuss with you when you see your doctor
5. Deep pain usually occurs with deep penetration and may be more pronounced with certain positions. Causes include: endometriosis, uterine prolapse, irritable bowel syndrome, hemorrhoids and ovarian cysts.
6. Finally, emotional factors can play a role.
Many women with persistent sexual pain never seek medical attention. Don’t be one of them. If you are experiencing painful intercourse, talk to your doctor. Treating the problem can do wonders for your sex life, your emotional intimacy and your self-image.

What does a doctor do to diagnose Dyspareunuia 

Examination of genitals :

Doctor examines whether any Sexual Development defect is present or not. For this vaginal size is measured by vaginometer or Genitometer or by radiological tests. The vagina is examined for any local problem. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked.
Nerves supplying the female genitals examined by sensation testing, Deep Tendon reflexes.
Then other systems are examined.

INVESTIGATIONS i.e. DIAGNOSTIC TESTS:

Step 1 - HORMONE TESTING
Various Female sex hormones & other associated Hormones are tested by latest-immunoassay techniques. These hormones includes total Estradiol, Estriol, Prolactin, LH, FSH, T3, T4, TSH others as Cortical, E2, Free testosterone SHBG etc. Among above tests relevant hormones are tested in that particular patient. Results are available in 36 hours. If any abnormality in hormonal assays is found, simple correction of these hormone disorder corrects the pain problems in two months time. Blood glucose & other systemic tests are also done.

Step 2 - ULTRASOUND SCANNING
Ultrasound scanning is done to decide whether any type of local problem is present or not, accordingly treatment is prescribed.

Step 3 - SEX COUNSELING
For counseling the doctor/psychologist takes detail history of sexual development, her thoughts, her misconception about sex, her old experience in sex, her unconscious fears about sex. This counseling session unravels all the hidden psychological causes of sexual pain disorder.

Step 4 - OTHER TESTS (If required)
1) Pelvic Nerve Testing: By conduction and sensory testing (NCV, EMG).
2) Psychoanalysis: To find different factor leading to psychogenic pain disorder.
3) Detailed Sex Counseling

TREATMENT OF PAINFUL INTERCOURSE
1)Hormones Therapy: Estrogen treatment is given when deficiency of hormones are found. Hormone therapy usually cures the Hormone problem in 2 to 3 months time and they do not have any adverse effects as they given to only those patients in whom some hormone disorder is found.

2) Anti-infective drugs: The anti-microbial treatment is indicated whenever the infection is found.
3) Sex Therapy: The various sex therapy is a psychotherapy that will have very promising results especially in combination with medicines.
4) Other drugs found effective are anti-inflammatory, serotonin re-uptake inhibitors.