Dyspareunia: definition, symptoms, diagnosis and treatment

By Cristiano Antonino On Apr 11, 2023

Counted among the Female Sexual Dysfunctions (FDS), dyspareunia is a painful condition that afflicts women during sexual intercourse and, in serious cases, can compromise the life of a couple

There is also a form of male dyspareunia: however, in men, genital pain during intercourse is usually caused by documented and well-defined irritation and bacterial infections.

In women, on the other hand, pain in the vagina and pelvic area generally has a combination of unclear and ill-defined causes and is strongly influenced by psychological factors.

It should not, however, be confused with vaginismus.

While vaginismus is a kind of ‘blockage’, an involuntary contraction of the muscles surrounding the vaginal orifice, making it impossible to even initiate sexual intercourse, dyspareunia pain is felt when intercourse is in progress.

Its incidence is truly remarkable: about 12-15% of women suffer from it, but the percentage rises to 40% after the menopause.

However, only a few patients talk about it with their gynaecologist and the condition is hardly treated with the importance it deserves.

Dyspareunia: What is it?

Dyspareunia, rather than a pathology, is a form of pain.

It does not always manifest itself in the same way and with the same degree of intensity, and it is possible to identify different types of dyspareunia.

The first distinction is between superficial and profound dyspareunia.

In the first case, the pain is ‘external’ and is felt as soon as penetration begins; in the second case, the pain is felt in the lower abdomen and may continue even when intercourse is over (in a small percentage of cases).

A second distinction concerns the time at which the pain appears: primary (or lifelong) dyspareunia occurs from the first sexual intercourse in life, while acquired dyspareunia occurs after several years.

Lastly, a distinction is made between situational dyspareunia when the woman experiences pain only with a specific partner or at the occurrence of well-defined and recognisable surrounding and generalised dyspareunia when it is present all the time.

The pain, localised to the vagina or pelvis, is chronic. As seen, it may occur only at the beginning of intercourse, or for the entire duration.

It may appear after a period of sexual inactivity, it may affect one partner or all partners, it may occur all the time or only when assuming certain positions.

A study published in BJOG: An International Journal of Obstetrics and Gynaecology confirmed its prevalence: 10 per cent claim to experience pain during intercourse, especially in the first years of sexual activity (between the ages of 16 and 24) and after menopause.

The causes of dyspareunia are diverse and often occur together:

multisystem dyspareunia is due to an impairment of the immune, endocrine, vascular, peripheral and central nervous systems;
multifactorial dyspareunia presents sexual causes on a physical and psychological basis;
complex dyspareunia simultaneously presents characteristics of multisystem dyspareunia and multifactorial dyspareunia.

Physical or psychogenic, the main risk factors for the development of dyspareunia are:

anatomically based abnormalities of the hymen or vagina
previous trauma or surgery to the vagina
scars from episiotomies
diseases of the ovaries, uterus or pelvis
endometriosis
urinary infections
genital malformations
stress (this is both a concomitant cause and a consequence, since those suffering from dyspareunia experience the situation with great discomfort, facing the next intercourse almost with fear)

To identify the causes, it is necessary to focus on the site of the pain.

Mid-vaginal dyspareunia is characterised by contraction of the elevator muscle of the anus, which is not the case with introital dyspareunia.

Causing both types is most often vulvar vestibulitis, an inflammation of the tissues surrounding the vagina.

Deep dyspareunia, on the other hand, is typically caused by endometriosis, pelvic varicocele, abdominal nerve entrapment syndrome, or pelvic inflammatory disease.

When pain is felt on the surface, causes can also be

poor vaginal lubrication (due to lack of foreplay, advancing age, breastfeeding or long-term use of antihistamines)
inflammation or infection of the vagina or genital area
genital hypersensitivity to pain (a condition called hyperalgesia)
injury
involuntary contraction of the muscles of the vagina
latex allergy
genetic abnormalities
previous radiotherapy resulting in fibrotic outcomes
previous surgery resulting in a reduction or alteration of the normal anatomy of the vagina

When pain is felt in depth, the causes may also be

infection of the uterus, cervix or fallopian tubes
tumours
ovarian cysts
adhesions between the pelvic organs (caused by infections, surgery or radiotherapy)

However, the role of a psychological factor should also not be underestimated.

Pain may occur as a result of previous violence or molestation, but also due to a decrease in desire or traumatic childhood episodes.

Or, it may arise from a relational cause such as dissatisfaction with one’s sex life or a lack of attraction to one’s partner.

Dyspareunia, the symptoms

The main symptom of dyspareunia is pain, whether superficial or deep.

Related symptoms are related to its cause.

It is possible to experience intimate itching, vaginal dryness, inability to use tampons, burning and bad odour.

Diagnosis

A woman who frequently experiences pain during sexual intercourse, in the absence or presence of other symptoms, is advised to consult her gynaecologist.

Since this is a delicate condition with often psychological and relational implications, it is important to turn to a professional with whom one has or believes one can establish a relationship of trust.

In fact, the diagnosis of dyspareunia is mainly based on anamnesis, analysis of the woman’s medical history and listening to her symptoms.

The gynaecologist will then examine the patient to assess the presence of the specific organic pathologies that may favour the onset of dyspareunia.

Where indicated, the specialist may prescribe any laboratory or instrumental tests that he or she deems necessary.

Once he has all the answers, he will formulate his diagnosis and suggest the most suitable therapy to the woman.

Dyspareunia, treatments

There is no single cure for dyspareunia.

Since it has different causes, and the psychological sphere is involved, treatment must be based on the individual patient and her medical history.

If there is an organic pathology at the root of the pain, the doctor’s priority will be to set up a therapy aimed at eradicating it; if there is no physical problem, the specialist will recommend a psychotherapeutic course.

Single and/or couple, therapy with a psychologist or sexologist can destroy step by step the fears and negative thoughts that often underlie the pain.

Conversely, the abuse of anxiolytic drugs worsens the problem as does the refusal of intimate situations.

Treatments for dyspareunia include rehabilitation exercises for the pelvic floor.

Knowing how to recognise the pelvic muscles, how to control and train them, helps to reduce the painful sensation.

This can be done by holding your pee for a few seconds while urinating, and contracting the perineum muscles for thirty seconds about ten times while lying on your back.

An even more useful, but more complicated, exercise consists of contracting the muscles for fifteen seconds while imagining that you are pulling a ball up the vaginal canal.

Vaginal balls are also useful against dyspareunia, the function of which is precisely to train the pelvic muscles.

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However, one must choose models that fit one’s body well, starting with light weights to be increased over time.

If the greatest discomfort is caused by penetration, which is intense as the presence of a ‘foreign body’, vaginal dilators help you get used to this sensation.

Fundamental and the first step to resolving dyspareunia is not to ignore the disorder.

Although it can cause anxiety, feelings of inadequacy and shame, it is through dialogue that ‘healing’ begins.

By communicating with the partner, it is possible to explain and suggest how to act to alleviate the painful sensation, especially if this is a consequence of certain positions.

The woman can ask him to increase foreplay (since it stimulates lubrication), to decrease the intensity of penetration.

If the pain persists in the absence of organic dysfunction, psychotherapy is again recommended.

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