Women who experience persistent or recurrent pain during intercourse don’t have to suffer in silence. Painful intercourse, known as dyspareunia, is a common problem that can be caused by physical or psychological factors. It is usually easily treated.

“Though dyspareunia can also affect men, it is more common in women, particularly postmenopausal women. The genital pain can occur during or after sexual intercourse,” says Dr Yong Tze Tein​, Senior Consultant, Department of Obstetrics & ​Gynaecology, Singapore General Hospi​tal (SGH), a member of the SingHealth​ group.

Symptoms of dyspareunia

A woman with dyspareunia can experience pain in the vagina, urethra or bladder. Dyspareunia symptoms include the following:

• Pain at penetration (entry) during sexual intercourse
• Constant pain during intercourse
• Pain during intercourse under certain circumstances
• Deep pain that occurs during thrusting
• Pain during intercourse accompanied by burning and itching
• Pain after intercourse

Dyspareunia symptoms will vary depending on the underlying cause.

Causes of dyspareunia

There are numerous physical and psychological causes of dyspareunia. Physical causes are varied and can range from infections to pelvic trauma to disorders of the uterus and ovaries. Problems with these reproductive organs usually cause deep dyspareunia pain. Psychological causes can be related to relationships and stress.

Physical causes of dyspareunia

• Vaginal infections and urinary tract infections (UTIs)
• Skin conditions in the genital area, e.g. eczema
• Vaginismus – involuntary tightening of the vaginal muscles
• Vaginitis – inflammation of the vagina
• Vaginal dryness – this can be associated with menopause, childbirth, breastfeeding and certain medications, e.g. antidepressants, antihistamines
• Pelvic injury or trauma, e.g. pelvic surgery, radiotherapy, pelvic inflammatory disease
• Endometriosis
• Uterine fibroids or ovarian cysts
• Sexually transmitted diseases (STDs)
• Irritable bowel syndrome (IBS)

“Intercourse too soon after surgery or childbirth, before complete wound healing, can result in dyspareunia,” says Dr Yong. It is important to wait at least a few weeks after childbirth before having sexual intercourse.

Psychological causes of dyspareunia

• Stress
• Anxiety or depression
• Fear of intimacy
• Fear, guilt or shame related to sex
• Self-image issues
• Relationship problems

Treatment for dyspareunia

A doctor will diagnose dyspareunia after taking a thorough medical history from the patient and carrying out a pelvic examination. Further tests such as a pelvic ultrasound, urine culture test, and allergy test may be required.

Dyspareunia treatment will depend on the cause. Physical causes are typically treated with medical intervention. Medications such as antibiotics and antifungal medication may be prescribed to treat infections while topical creams and lubricants may be used to relieve vaginal dryness.

Psychological causes may require counseling or sex therapy to revive communication and intimacy in the relationship. Exercises, such as Kegel exercises, may be recommended to improve control of the vaginal muscles.

“Dyspareunia in postmenopausal women usually occurs because of vaginal dryness due to fluctuating hormones. It is effectively treated with a cream or drug which releases small doses of oestrogen directly into the vagina,” says Dr Yong.

Treating dyspareunia at home

If you suffer from dyspareunia, you can take simple steps at home. These steps are best taken before you have sex. You can:

• Empty your bladder fully.
• Take a warm bath.
• Take a painkiller.
• Use a water-based lubricant.
• Apply an ice pack to the vulva.
• Communicate your pain to your partner.

“Changes to your normal sexual routine such as shifting positions can also reduce dyspareunia symptoms,” says Dr Yong. “Longer foreplay gives more time for stimulation and encourages natural vaginal lubrication.”

Ref: R14