Thursday, March 28

Sexual intercourse that causes pain: what can be done in the face of dyspareunia


Is named dyspareunia to persistent or recurrent genital pain in women before, during or after sexual intercourse. It is one of the most frequent sexual dysfunctions, and causes numerous damages, both for the physical and mental health of the person who suffers from it and for the couple’s relationship.

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For some time now, dyspareunia has become “One of the most frequent complaints in medical and sexological consultations”, as explained in a Article on the matter Manuela Velázquez Barrios, Desireé Díaz Jiménez and Antonio José Reina Caro, specialists in obstetrics and gynecology.

This increase in frequency -explain the authors- is not because this disorder has spread, but because “women, and society in general, are becoming more exempt from taboos that previously meant that they were not consulted for this type of problem”.

However, strictly speaking, dyspareunia is not a sexual problem, but a sexual problem. “genital pain that interferes with intercourse”. This is specified for his part by Jorge López Olmos, a gynecologist at the Arnau de Vilanova Hospital, in Valencia, in a analysis of the causes of this disorder.

How many women suffer from this problem? The figures vary markedly depending on the diagnostic criteria and the population samples analysed, but the studies They claim that it could affect up to 55% of women after menopause.

Physical causes of dyspareunia

To know how to treat dyspareunia, it is essential to know its causes, which can be many and varied, of physical or psychological origin. Among the physical causes, the most common is insufficient vaginal lubrication.

One of the most common reasons for such insufficient lubrication is a lack of stimulation prior to penetration. But it can also be due to a drop in a woman’s estrogen levels, a characteristic of menopause but also after childbirth and during lactation.

Certain medications can also affect vaginal lubrication, explains a document from the Mayo Clinicfrom the United States: the antidepressants and sedativesantihistamines (especially indicated against allergies), those prescribed against high blood pressure and some birth control pills.

Another common cause of dyspareunia is infections, inflammations, or skin disorderssuch as eczema. These conditions, both in the genital area and in the urinary tract, are quite common, and can also cause pain during sexual intercourse.

The presence of irritation, injury, or trauma in the vaginal area it also usually causes pain during intercourse. Such ailments can be the result of an accident, surgery in the pelvic area, or an episiotomy, the cut that is sometimes made during childbirth to enlarge the birth canal.

There is another sexual pain disorder: vaginismus, which consists of the involuntary contraction of the muscles that surround the vagina. This sometimes prevents penetration; in others it doesn’t, but it makes it painful and unsatisfying. It is, therefore, another cause of dyspareunia.

There are some other physical causes, less frequentsuch as certain diseases (endometriosisuterine fibroids, cystitis, etc.), cancer treatments, or abnormalities present at birth (such as a vagina not fully developed or blocked by a membrane, in a condition called imperforate hymen).

The effect of psychological factors

The psychological factors that can cause dyspareunia are also varied. Many of them prevent reaching “a state of sufficient sexual arousal so that the necessary changes to receive the penis occur, at an anatomical and physiological level”, according to the aforementioned work by Velázquez Barrios, Díaz Jiménez and Reina Caro.

Consequently, intercourse generates discomfort or pain. These psychological factors can range from stress, anxiety and depression to conflicts in the relationship, fear of intimacy, some type of erotophobia either sexual phobia and even body dysmorphic disorderthe pathological preoccupation with physical imperfections.

And we must also mention, among the psychological causes of dyspareunia, the history of sexual abuse. In many cases, there is an interaction between physical and emotional reasons, which requires a comprehensive treatment of the problem in order to solve it.

Measures and treatments against dyspareunia

With so many possible causes, diagnosis often requires a multidisciplinary approach and carrying out a complete and systematic examination, in order to understand as accurately as possible the specific causes of the pain. This is how one explains review of studies published by US scientists in 2018.

Likewise, the treatments usually include actions related to different perspectives: from tips related to sex education and cognitive behavioral therapy to physiotherapy and drugs. In some cases, even surgical intervention may be necessary.

Vaginal lubrication problems are sometimes fixed with a change in sexual practices: Achieving high levels of stimulation and arousal before intercourse may be the key. Gestures and actions such as kisses, caresses or masturbation (individual or mutual) are essential in this regard.

When the reasons have to do with a low amount of estrogen or the intake of medications, products can be resorted to. lubricants or moisturizers. The treatment can also be hormonal, through topical estrogen “which is applied directly to the vagina”, as explained by the Mayo Clinic.

If the disorder is derived from some infectious agent or other disease, what is sought is, of course, identify and delete. To that end, the doctor will usually prescribe the appropriate medication.

The sex therapy or cognitive behavioral, meanwhile, helps reduce or suppress the effect of psychological factors that cause dyspareunia. This kind of treatment may require somewhat longer periods, but it is essential to resolve couple conflicts, phobias or traumas caused by traumatic episodes.

Otherwise, it is sometimes also possible to use the physiotherapy (when excess tension affects the muscles around the genitals), vaginal laser treatments (which improve genital hydration and the elasticity of the vaginal walls) and surgeries (reserved for very specific cases, with morphological alterations, and in which other treatments have not worked).

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