DYSPAREUNIA

General Information

DEFINITION--Recurrent and persistent genital pain for a woman during sexual intercourse.

BODY PARTS INVOLVED--Vaginal muscles; hymen (sometimes); uterus (sometimes); brain.

SEX OR AGE MOST AFFECTED--Sexually active females of all ages.

SIGNS & SYMPTOMS--Pain in the genital area during sexual activity, including foreplay, intercourse or attempted intercourse. Pain may be mild or severe, and it may vary with different intercourse positions.

CAUSES

Physical causes include:

• Infection of the genitals, including herpes and others involving the vagina, cervix, Fallopian tubes or ovaries.
• Pressure against the vaginal wall caused by scarring from operations or radiation treatment.
• A tight episiotomy scar from vaginal repair after childbirth.
• A fibroid or other uterine tumor.
• Endometriosis.
• A hymen that is torn or thicker than normal.
• A bruised opening to the urethra.
• Inadequate vaginal or condom lubrication.
• Allergic reactions to diaphragms, condoms or contraceptive foams and jellies.
• Dryness and thinness of the vaginal wall after menopause.
• Pelvic inflammatory disease.

Psychological causes include:

• Fear of pregnancy.
• Fear of injury to the unborn child during pregnancy.
• Lack of sexual arousal and vaginal lubrication caused by inadequate sexual foreplay, aversion to a sexual partner, fatigue or anxiety.
• Lack of sexual experience or information.
• Past sexual injury or psychological trauma.
• Temporary lack of desire for sexual partner.

RISK INCREASES WITH

• Stress, recent illness.
• Fatigue or overwork.
• Alcohol consumption.

HOW TO PREVENT

• Obtain medical treatment if you have symp-toms of infection of the reproductive organs.
• Discontinue use of contraceptive foams or jellies that produce allergic reactions.
• Obtain professional counseling to resolve feelings about past sexual trauma.
• Discuss the lack of sexual arousal with your partner, including ways to improve foreplay. Enlist your partner's support and patience to overcome the problem. Use a lubricant, if necessary.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory studies, such as a Pap smear (See Glossary) and culture of any vaginal discharge.

APPROPRIATE HEALTH CARE

• Appropriate treatment will be directed to physical causes or psychological causes.
• Correction of any underlying disease, injury or structural defect.
• Treatment for psychological causes will vary depending on the needs of the patient. It can involve education about contraception, counseling to uncover hidden conflicts, sensate focus exercises and teaching of appropriate foreplay techniques.

POSSIBLE COMPLICATIONS--Damage to personal relationships, permanent inability to enjoy sexual experiences and loss of self-esteem.

PROBABLE OUTCOME--Depends on the cause. Medical disorders are usually curable with treatment. Psychological problems can often be cured with therapy, and interpersonal problems can improve with communication and patience.

How To Treat

GENERAL MEASURES--

• Sitz baths frequently relieve tenderness. Sit in a tub of hot water for 10 to 15 minutes. Repeat baths as often as 3 or 4 times a day.
• Use a non-prescription lubricant, such as baby oil or K-Y Lubricating Jelly, during sexual intercourse.
• Your doctor may provide instructions for exercises or techniques to dilate the vagina.
• Try different positions for sexual intercourse to discover new ones that might reduce penile penetration and be pain-free.

MEDICATION--Your doctor may prescribe antibiotic, antiviral, or antifungal medications for underlying infection.

ACTIVITY--No restrictions.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of dyspareunia.
• Pain worsens, despite treatment.
• Symptoms don't disappear after 3 months of treatment.