Dyspareunia Health Article

Diagnosis

About 30% to 40% of all women who seek help from a sexual counselor for dyspareunia turn out to have a medical problem that is causing their pain. A full medical examination is necessary to rule out a possible medical cause. This includes a pelvic exam and may also include an ultrasound, as well as other diagnostic tests. Examples of possible physical causes are infections, sexually transmitted diseases (STDs), estrogen deficiencies, and vulvar vestibulitis.

Once a medical cause is ruled out, a full family and sexual history can help pinpoint possible psychosocial causes. A psychological evaluation can determine the cause of the problem. Women who have been raped or abused may also suffer from post-traumatic stress disorder (PTSD) or generalized anxiety disorder.

There are two types of dyspareunia. Lifelong or primary dyspareunia means that the condition has been present for the entire sexual life of the affected person. This type is usually associated with being raised to believe that sex is bad, sexual abuse, fear of sex, or a painful first sexual experience. Acquired or secondary dyspareunia begins after a period of normal sexual function. It often has a medical cause, but may be a result of some sort of trauma, such as rape.

Treatments

Counseling is often helpful to identify and reframe negative feelings about sex. Couples therapycan help improve communication between partners and resolve problems that may be a factor in the sexual relationship. Women who have been abused or raped may benefit from counseling techniques designed to help overcome fears and issues caused by traumatic experiences.

Sex therapy may be offered to provide information about the physical aspects of arousal and orgasm. A sex therapist will also offer suggestions for how to improve sexual technique. For example, increasing time for foreplay and allowing the woman to control when and how penetration occurs can help her to relax and become aroused more easily.

Women who also have vaginismus may be given a set of devices they can use at home to dilate the opening of the vagina. Affected women start with a very small device and gradually work up to a penis-sized device, proceeding to a larger size only when they can use the smaller one without pain or fear. This retrains the vaginal muscles and helps the involuntary muscle tightening of vaginismus.

Use of a vaginal lubricant, at least temporarily, may be helpful in some women to reduce anxiety about possible pain.

There are no specific medications that treat dyspareunia. Medications that increase blood flow or relax muscles may be helpful in some cases.

Prognosis

With treatment, the chance of overcoming dyspareunia and having an enjoyable sexual life is good. Treatment can take several months, particularly in the case of survivors of a violent trauma such as rape.

See also Erectile dysfunction; Post-traumatic stress disorder

BOOKS

Hales Robert E., Stuart C. Yudofsky, and John A. Talbott, eds. The American Psychiatric Press Textbook of Psychiatry. 3rd ed. Washington DC: American Psychiatric Press, 1999.

Sadock, Benjamin J. and Virginia A. Sadock, eds. Kaplan & Sadock's Comprehensive Textbook of Psychiatry.7th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Jody Bower, M.S.W.