Dyspareunia

Why Dyspareunia?

Definition: 

Dyspareunia is the medical term for painful intercourse.  It is often defined as persistent or recurrent genital pain that occurs before, during or after intercourse.  Thirty three percent of women will experience pelvic pain at some time in their life.

Causes: 

There are many causes of dyspareunia and often it is present with other medical conditions including but not limited to:

• Insufficient lubrication which is common during times of hormonal change such as pre/post partum,  peri-menopause and  menopause.

• Injury/trauma or irritation such as with surgical scars or episiotomyInflammation, infection or skin disorders such as eczema, chronic yeast infections and urinary tract infections

• Muscle spasm which can be present in response to pain or because someone holds their stress in the pelvis just as others hold their tension in their shoulders

• Systemic illness such as endometriosis, irritable bowel syndrome, and cystitis

• Supportive issues such as prolapse and hysterectomy

• Musculoskeletal disorders such as hip or low back pain

Treatment:  

Most women with dyspareunia have a care team that they work with.  This team includes you, your physician, your physical therapist and possibly a mental health counselor, a pain management specialist or other specialists that you and your team feel would be helpful.  You and your healthcare team will need to be detectives and work together to determine your best course of treatment.  Try to be patient with the process, and let go of exact time frames.  If possible, develop short-term goals that you discuss with your team.Treatment will possibly include:

• Medications: Prescribed by your physician and applied to the vulvar skin and/or taken orally.

• Physical Therapy: Intervention will include massage techniques, relaxation training, stretching, strengthening of weak muscles, postural training and coordination of the muscles that support your core.  Your therapist will evaluate your back, hips and possibly your rib cage region to see if there are any imbalances in those regions contributing to your pain.   You will also be taught self-care techniques for you to utilize at home and possibly with your partner.

• Counselor: if you are not already working with a mental health therapist, finding one that you can work with to assist you with identifying and changing any patterns, stress or fear regarding intimacy will likely be helpful.

The ‘Head’ Part of This:

Please remember that this is not all in your head but there is a ‘head’ component.  When intercourse is painful our muscles naturally contract to protect from the pain.  This is just like if every time you saw a particular person that person punched you in the arm.  Eventually every time that person came near you, you would protect yourself by tightening up your arm and trunk in anticipation of the pain. Similarly if intercourse hurts your body will tighten up in the pelvic region in anticipation of the pain.

This anticipation of pain can lead your nervous system to react with a cascade of events leading to even tighter muscles, vaginal dryness and loss of lubrication.  When this happens, intercourse becomes even less comfortable, resulting in more pain.

As you proceed through the healing stages of dyspareunia, focusing on the small accomplishments will be a huge benefit for progress overall. In general, small victories are essential in permitting you to gain confidence that your situation will improve.

Find resources to consult regarding your situation. You may have local pelvic pain support groups available to you. There are excellent websites, books and other resources available. Some books include:

• The V BookHeal Pelvic Pain

• Stop Endometriosis and Pelvic Pain 

• Please understand you are not alone. Many women suffer with similar issues, and there are ways to get help!

Find people who can serve as healthy resources such as a therapist, a friend who may understand, a confidante, a doctor whom you trust, or someone else in your care chain that can help you with some perspective and assistance. You never have to feel like you are alone, and it is best for you to get the support you need.