What is Dyspareunia?
Dyspareunia is painful sexual intercourse that happens because of medical or psychological causes. Dyspareunia occur mostly in women with a small percentage occurring in men.
There are many genuine physical causes that make normal sexual activity painful. Here are some of the main reasons, although the list is certainly not complete.
- Malformations of the lower female genital tract can occur. These may physically make the insertion of the erect penis nearly impossible.
- Previous surgery. Much surgery is carried out in the pelvic region. After this, because of the scarring or other related reasons, discomfort can take place. In younger women, childbirth with tears or an episiotomy (where the entrance is surgically widened to allow the baby’s head to come through) may heal, but leave an acutely tender area over the scar, which can remain this way for many months and years. Older women often suffer discomfort following a “repair operation.” Here the vaginal walls, having lost elasticity; tend to cave in, and they must be tightened and the lax tissue removed. Discomfort after these operations is well-known.
- Infections. Vaginal infections of any kind can make the lining very tender. Trichomonal and monilial infections are notorious for this, and can destroy the delights that were previously experienced with normal intercourse. Any vaginitis, whatever the cause, can have a similar effect.
- Tumors. Growths of the pelvic area, particularly the rectum or vagina, may make normal penetration difficult and give rise to discomfort. Most of these conditions will produce discomfort when an attempt at insertion is made. Some women find that it is only with deep penetration that pain takes place. Some of the more likely reasons for this include:
- Chronic pelvic infections. Any infection anywhere in the pelvic organs is a possible cause of this problem. Infection can occur in the cervix or the body of the uterus. It may take place in the tubes or in the ovaries themselves, or the overlying pelvic lining may be involved. IUDs may also cause womb infection.
- Endometriosis. This is probably the most common cause. Cells from the endometrial lining of the womb grow on other pelvic organs. Besides causing severe dysmenorrhoea, pain with intercourse is common and may be severe.
- Adhesions. Sometimes adhesions from previous pelvic or low abdominal infections can be a precipitating cause. This means that thin bands have grown from one organ to another. For instance, the womb, ovary or tube may be adherent to part of the bowel or to the front wall of the abdomen. When in certain positions, these may pull and this can readily be aggravated by intercourse. Many such cases have been reported and relief has been rapid when the adhesions have been severed by surgery.
- Advancing years. Women who have passed the menopause often notice a thinning of the vulva and vaginal tissues, and a drying out. This is due to the lack of circulating female hormone, and an atrophic vaginitis commonly occurs that makes intercourse more difficult and uncomfortable. It is an age-related problem but fortunately it is very amenable to treatment.
- Partner problems. Coming toward the end of the list of probabilities, the fault may lie essentially with the husband. Some have a gross ignorance of the normal female anatomy, and have little appreciation of the basic techniques of lovemaking. Selfishness, clumsiness, the desire for personal sexual gratification at the expense of all else, inadequate ability or knowledge about pre-sex foreplay, are just some of the male-orientated reasons why the female partner may suffer as a result.
- Other reasons. Many other potential reasons exist. A tender, prolapsed ovary may be pressed on with deep penetration. This may elicit pain. A retroversion, not a common cause, but often present in women with dyspareunia, may be a precipitating feature.
- Non-reasons. Hardly ever is the old myth of “disproportion” a reason. This assumes that the wife is “too small” and the husband is “too big.” Clinical trials have established that practically any penis will fit any vagina. Neither is the hymen a common or valid reason. Usually what fragments of this remain are quickly stretched, and rarely act as a mechanical barrier to penetration. Very rarely a rigid remnant may be present, but this invariably responds to gentle stretching and an erect penis is by far the best instrument for accomplishing this.
Now that many of the basic physical reasons have been checked, there still remains a massive aspect that some doctors believe is larger than all the others put together.
These are, in effect, mentally orientated reasons. To be sure, the problem is basically a physical one, but the underlying reason is attributed to what is occurring in the mental processes.
This usually presents in the form of a condition called vaginismus. This condition is due to a sudden tightening of the muscle fibers surrounding the vaginal entrance. Often the muscle spasm is so vigorous that penetration is utterly impossible.
Even an experienced and understanding physician trying to carry out a vaginal examination in the surgery will evoke a similar response, and it may be impossible to conduct an examination.
In some cases not only are the muscle fibers surrounding the vagina involved, but the muscles of the whole pelvic floor and even the muscles of the thighs that involuntarily cause them to close may contract vigorously. (This is so well-known that these muscles have often been referred to in semi-jest as “the pillars of virginity.” Certainly, when in action, they would seal a woman’s chastity.)
Almost always this condition arises from impulses being sent down from the brain. The girl’s basic upbringing and her early training invariably play a major part. Those with very severe, religious upbringings tend to fare worse. The inherent idea with which a former generation was deluded by well-meaning but completely out-of-touch parents that sex is dirty, that intercourse is not for nice people, that God abhors the things that go on in marriage, all play a major part when it comes to this problem.
In rarer instances, a sexual assault in a girl’s early life may have permanently scarred her subconscious. Or the clumsy attempts made by the husband on the nuptial bed may have created such emotional havoc that the memory lingers on. In all these instances, an inherent fear is the basic cause.
Any woman suffering from dyspareunia should consult her own family doctor. Alternatively she may be referred to a competent gynaecologist, who may be more expert in this field and more attuned to the complexity of the situation and the wide range of causes.
Often a brief physical examination will take place, and this will be followed by a more detailed pelvic check.
The gynaecologist will make every effort to find if there is any physical or pathological reason for the symptoms. If one or more can be found, then so much the better. Treatment will then be directed to therapy aimed at lessening that particular complaint.
Often infections can be treated with specific medication, already outlined in this section. Deeper infections may require antibiotics, possibly for a long time.
If an IUD has been in place for many years, it should be removed. It is incredible how infection can continue to smolder on silently for years with these devices in place. The new copper IUDs are replaced at 5 – 8 yearly intervals. If there appears to be some internal disorder that cannot be accurately pinpointed, such as adhesions or misplaced pelvic organs, a surgical investigation may be recommended.
Today, with the ready availability and widespread use of the laparoscope, it is possible for the doctor to gain an amazing internal view of the total pelvic and abdominal, contents. So instead of the hapless patient being subjected to the trauma (mental and physical) of the old-time laparototny (investigation operation where a large incision was made into the pelvis), the laparoscope via a tiny incision about 1 centimeter long can gain very useful and valuable information about any possible defect inside.
Certain abnormalities may be treated at the same time via the laparoscope. The entire operation may last less than half an hour, and the patient (who has an anesthetic) may be allowed to leave hospital all in less than one day.
Older women who are experiencing problems due to their age and obvious lack of hormones often benefit from the insertion of oestrogen suppositories or creams into the vaginal tract on a regular basis. If the outer parts are uncomfortable steroid creams can often assist.
Simple, surgical lubricating jellies make penetration much easier. Oestrogens orally in small doses for short periods of time also assist tremendously. This simple treatment often brings excellent results.
Discussion Can Help
If no pathological basis can be found to account for the problem, a discussion into the couple’s relationship should occur, preferably with a doctor specializing in sexual problems.
This is often carried out with the male partner present at the same time. Specific attention is paid to lovemaking techniques. Often a husband will become a little wide-eyed when he discovers that the basic cause could lie with him, and his total ignorance or at best inadequate knowledge on how to go about satisfying his wife’s sexual needs unfolds.
Some women who have a so-called “low sex drive” need special attention, and unless a husband is attuned to these needs, adequate sexual satisfaction will never come her way.
Often the use of simple lubricants can assist. The wife may be instructed on how to manually dilate her vagina; sometimes dilators are used, not so much for their dilating benefit but for the psychological reason of showing her that her vagina is quite capable of penile containment.
Sometimes surgical correction of a scarred and contracted vagina is required but this is not often necessary. Many couples see the entire sex field in a new light after time and effort has been taken to explain to them many of these fundamentals. Once the thinking has been corrected, and the subconscious mind has been retrained (but it may take a long time for this to be done completely), a new form of thinking can take over. No longer is sex a dirty word. No longer is penile penetration something that God forbids in the marital unit. No longer is it unchristian to have sexual desires. This is all part of the normal pattern of life, or living, or the desire to copulate and reproduce. It is all part of the planned system of having and rearing a family.
Once these attitudes win mental acceptance, a couple is then well on the way to success. Once the delights of uninhibited sexual joy have been experienced, a new world suddenly bursts forth, and the couple will find they have discovered a unity and fulfillment they never believed possible.