Painful Sexual Intercourse

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Sexual intercourse is meant to be fun filled and enjoyed by the two partners; however, some couple finds it painful and most times try to avoid having sex, this situation is known as dyspareunia in medical parlance. Dyspareunia is a term used for pain felt in the pelvis during or after sexual intercourse. It can affect men, but is more common in women.

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Superficial dyspareunia
This is pain felt in the vulva, at the vaginal entrance (introitus) and the lower part of the vagina. It typically begins with penetration or very early on after intercourse has begun, and is sore and instant. It is usually quickly relieved by stopping penetration, although you may be sore to the touch afterwards for a little while. The causes of superficial dyspareunia are usually local problems of the vaginal and perineal skin (the perineum is the area of skin between the vaginal opening and the back passage).
Deep dyspareunia
This is the pain felt deeper in the pelvis during or after intercourse. It can also spread to involve the fronts of the thighs. It may be sharp or dull, may stop when penetration stops or can continue for minutes or even hours. The causes of this type of pain usually lie rather deeper in the pelvis.
Causes of superficial dyspareunia are:
skin bridge: formation of a little bridge of scar tissue at the very back of the vaginal entrance (introitus) is common after childbirth, particularly if you have had a cut between the vagina and back passage (anus) – a procedure called episiotomy.
Intact hymen: it is a membrane that lines the vaginal opening. Early in your sex life the hymen is broken down by the act of having sex.
Vaginismus: is a powerful and often painful contraction of the muscles around the entrance to the vagina (the pubococcygeal muscles), which makes penetration painful or impossible.
Female genital mutilation: female genital mutilation, also referred to as female circumcision, involves varying degrees of mutilating surgery to the external genitalia of a woman.
Vaginal abnormalities: abnormalities of the vagina itself make sex painful or even impossible. These include pieces of extra tissue inside the vagina which are present at birth.
Causes of superficial and deep dyspareunia
Vaginal trauma: the vagina is pretty flexible and strong and usually recovers well from the stretch and (sometimes) small tears of childbirth. However, more significant trauma to the vagina – for example, from traumatic childbirth or mutilation – can lead to scarring, and then to pain and difficulty during sex (intercourse).
Vaginal or genital infection: infections of the vagina and the area around it cause inflammation of the tissues and so commonly cause pain on having sex. Infection may be with thrush, with viruses such as herpes, and with germs (bacteria).
Vaginal dryness: some pain during sex is due to lack of lubrication, meaning that the vagina is too dry. Normally, the vagina produces secretions which keep it moist, and these increase during sexual arousal. If there is no enough foreplay, or you are not aroused enough, you may not produce enough secretions to make penetration comfortable.
Some drugs can cause vaginal dryness, including some contraceptive methods like the intrauterine system (IUS).

Vaginal dryness is also associated with a condition called Sjögren’s syndrome, in which the body’s secretions are generally rather reduced; it is also associated with rheumatoid arthritis. Finally, pregnancy itself can make the vagina dry during intercourse.
Vaginal atrophy: after the menopause the levels of hormones in your body fall – particularly the level of oestrogen. Oestrogen is the hormone that keeps the vaginal wall strong and resistant. It increases the blood supply and the level of secretions and makes the wall softer and more stretchy. Therefore, when oestrogen levels fall after the menopause, the tissues become thinner, less stretchy and less well lubricated. Sometimes they can become as fragile and delicate as the vaginal tissues of young girls (who have not yet reached puberty and started their periods). The reason for these changes is quite logical: nature does not expect postmenopausal women to try to have sex, as they cannot have babies.
Cervical pain: the neck of the womb (cervix) should not normally be painful. However, if can become infected by many of the organisms which can infect the vagina – particularly herpes. If the cervix becomes inflamed then knocking it with the penis during sex may cause deep pain in the pelvis and sometimes across the fronts of the thighs. The cervix may also become tender and sensitive if you have an intrauterine contraceptive device, particularly if it is sitting a little too low.
Risk factors:
It occurs most frequently in:
Sexually inexperienced person
Peri- or post-menopausal person
Treatment
Treatment should be directed at the underlying cause:
Vaginal lubricants, local anaesthetic or pelvic relaxation exercises may also be helpful to break the cycle of spasms in women with vaginismus.
Hormone replacement therapy (HRT) can help symptoms associated with the climacteric, including atrophic vaginitis.
Surgery is required for pelvic masses and sometimes to remove chronically infected tubes or to clear endometriosis or adhesions.
In conclusion, the doctor must take a positive and sympathetic approach to get the best results, as there is often a combination of physical and psychological problems. Great care with internal examination is essential.

 



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