Dyspareunia Health Article

Definition

Dyspareunia is painful sexual intercourse. The same term is used whether the pain results from a medical or a psychosocial problem. Dyspareunia may be diagnosed in men and women, although the diagnosisis rare in men; when it does occur in men, it is almost always caused by a medical problem.

This discussion focuses only on pain with intercourse caused by psychosocial problems; therefore, only women's experiences are emphasized in this entry.

The professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, text revised (known as the DSM-IV-TR) classifies this condition as a sexual dysfunction.

Description

Dyspareunia is any pain experienced any time before, during, or following sexual intercourse. The pain may be located in the genitals or within the pelvis. It is not unusual for women occasionally to experience pain during intercourse. This is not true dyspareunia.

A woman who has dyspareunia often also has vaginismus. This is an involuntary tightening of the vaginal muscles in response to penetration. It can make intercourse painful, or impossible.

Causes

Psychosocial causes of dyspareunia include:

• Prior sexual trauma. Many women who have been raped or sexually abused as children have dyspareunia. Even when a woman wishes to have sex with someone later, the act of intercourse may trigger memories of the trauma and interfere with her enjoyment of the act. Vaginismus also often occurs in such women.
• Guilt, anxiety, or tension about sex. Any of these can cause tense vaginal muscles and also prevent arousal from occurring. People who were raised with the idea that sex is bad may be more prone to have this problem. Fear of pregnancy may make arousal difficult.
• Prior physical trauma to the vaginal area. Women who have had an accidental injury or surgery in the vaginal area may become sensitive to penetration. Vaginismus is common in these cases, as well.
• Depression or anxiety in general. Either of these can lead to loss of interest in sex. This can be experienced by either sex.
• Problems in a relationship. Dyspareunia may occur when a woman feels her sexual partner is abusive or emotionally distant, she is no longer attracted to her partner, or she fears her partner is no longer attracted to her. Men, too, can lose interest in sex because of prior emotional trauma in a relationship; however, the result is usually impotence, rather than dyspareunia.
• Vasocongestion. Vasocongestion can occur when either partner frequently becomes aroused but does not reach orgasm. Vasocongestion is a pooling of blood in dilated blood vessels. Normally, the pelvic area becomes congested with blood when a person becomes sexually aroused. This congestion goes away quickly after orgasm. If there is no orgasm, the congestion takes much longer to resolve.

Any of these factors may cause painful sex. The affected person may then associate pain with sex and find it even harder to relax and become aroused in future.

Symptoms

The DSM-IV-TRdiagnostic criteria for dyspareunia are as follows:

• Recurrent or persistent genital pain related to sexual intercourse that may occur before, during, or after intercourse.
• The affected person is distressed by the pain, or experiences relationship problems as a result of the pain.
• The pain is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for by another disorder, and is not due exclusively to the direct effects of a drug, medication, or a general medical condition. Dyspareunia can occur with other sexual dysfunctions.

The most common symptom of dyspareunia from psychosocial causes is pain at the vaginal opening as the penis enters the vagina. Entry may be difficult, and the pain may be burning, or sharp. The woman may have a sense of being "dry." Pain may continue or ease as thrusting continues.

Vasocongestion can cause an aching pain in the pelvic area that persists for hours after intercourse. Pain with orgasm, or pain deep in the pelvis with thrusting, is more likely to be a sign of a medical problem, but can result from lack of arousal and tension.

A person who experiences pain during sex may feel embarrassed or ashamed. Dyspareunia can cause problems in relationships or lead to the affected person avoiding relationships altogether.

Demographics

About 15% of women may have pain with intercourse at some point in their lives. About 1–2% have true dyspareunia. The incidence is much higher in women who have been raped or otherwise sexually abused. As stated, dyspareunia in men is rare and is almost always caused by a medical problem.