What is dyspareunia?
There are different areas that can hurt with dyspareunia: On the one hand, problems can occur at the vaginal opening, the labia majora, the clitoris, the perineum or even the anus. On the other hand, the internal sexual organs can also be affected, such as the uterus, the bladder, the ovaries or the rectum. In the beginning, many women’s vaginas simply feel dry. Then it starts to burn or itch, often feeling sore every time it is touched. Women feel pain when the man penetrates them, or a little later during sexual intercourse. Some people only feel this discomfort during an orgasm. While for some the pain subsides immediately afterwards, for others it persists for days.
The reason for such complaints can be infections. But physical changes are also often the cause. Chronic dyspareunia often occurs in conjunction with an overactive bladder. In many cases, those affected also suffer from severe psychosocial or emotional challenges. Many of them are perfectionists or experienced chronic stress in their childhood. A combination of psychological treatment and medication with exercise and relaxation techniques usually helps best. However, affected women need patience until their symptoms improve significantly.
Frequency and age
How often dyspareunia occurs remains largely unknown. Many women conceal their problem and would rather grit their teeth than seek help. It is estimated that between five and 20 percent of all women experience pain during sex. Many believe that these complaints are “normal” and that they have to put up with them. Dyspareunia can occur in women of any age, but is particularly common in very young women.
Dyspareunia: causes and risk factors
Dyspareunia is often also linked to cultural factors: How is sexuality talked about in a woman’s environment? What kind of relationship does she have with her body? What expectations does she feel exposed to? Previous traumatic experiences can also be the cause of dyspareunia, as can sexual abuse. Depression or burnout can also be associated with pain during sex. Chemotherapy for cancer often leads to dry genital mucous membranes. The menopause and breastfeeding with their hormonal changes are also usually associated with the vagina becoming less moist less quickly and less strongly during sexual arousal. Many women affected by dyspareunia are also particularly afraid of pain.
At the same time, however, dyspareunia is often associated with organic problems or infections.
Such infections can be:
- Vaginal fungus (candidiasis)
- Vaginitis (colpitis)
- Inflammation of the fallopian tubes or ovaries (adnexitis)
- Genital warts
- Sexually transmitted diseases (syphilis, trichomoniasis, gonorrhea)
- Inflammation of the Bartholin’s glands on the labia majora
- Tuberculosis
Other causes of pain during sex can be
- Endometriosis
- Dry vagina, especially after the menopause
- Scars after childbirth, for example due to a perineal tear
- Weakness of the vaginal wall (especially in older women)
- Benign tumors
- Intolerance to chemical contraceptives or intimate hygiene products
- Vaginismus (vaginal cramps)
- Skin diseases, such as lichen sclerosus or lichen planus
- Excessive muscle tension in the pelvic floor
- sexual dysfunction
- Pelvic vein syndrome (varicose veins in the pelvic area)
Symptoms: Dyspareunia
Either it already hurts when the man tries to penetrate her. Or they only feel the pain when the penis is already in the vagina and pushes against a certain spot. This pain can be very mild or so severe that it is almost unbearable. Some women with dyspareunia are also unable to insert tampons or even touching them hurts. Some women avoid sports such as cycling. The pain can manifest itself as burning, stinging, itching or soreness. The symptoms are often similar to those of vaginal candidiasis, which is why the disease is often confused with vaginal candidiasis. In many cases, dyspareunia occurs together with an overactive bladder – those affected have to urinate particularly frequently.
Dyspareunia: Diagnosis by us
In a detailed discussion, we try to find out exactly where the problems lie. We could ask questions like these:
- How long have you had the problems?
- Was there a trigger for this?
- Do you always have pain during sexual intercourse or only sometimes?
- At what exact moment do they occur?
- How does the pain feel?
- Do you have any other symptoms, such as bleeding or an urge to urinate?
- Do you experience sexual arousal despite the pain?
- Do you have problems with fungal infections of the vagina?
- Do you have other complaints, such as frequent bladder infections, lower abdominal pain or back pain?
A gynecological examination is then carried out. The problem is that for many patients it is not possible to insert the speculum to look inside the vagina. We try to localize exactly which parts of the vulva or vagina are hurting. We check whether the external (and if possible the internal) genitalia show any abnormalities. If possible, we will take a swab of the vaginal secretion to examine it for pathogens and fungi. An ultrasound examination of the internal reproductive organs is also useful to detect or rule out organic causes. We also observe the muscle tension of the abdomen and buttocks during the examination. If the examination shows that there are no organic causes for the dyspareunia, we usually ask about psychological and social problems or anxiety.
Dyspareunia: prevention, early detection, prognosis
If you know and like your body well, you are less likely to suffer from dyspareunia. It is therefore important to give girls a positive impression of their sexual organs right from the start. It starts with the terms: Only those who have words for them can deal with their organs. Even adult women often don’t know the difference between the vulva and the vagina. In many families and cultures, everything “down there” is considered a taboo subject. Sometimes sexuality is passed down through generations among women as a painful topic. An open conversation can help – at school, at the gynecologist’s, among friends or girlfriends. Sports, especially dance or belly dancing, can also provide a positive experience of your own pelvis.
If you are worried about your sexuality or have already experienced pain during sexual intercourse, you should talk to your gynecologist about it. If you deal with the issue early on, you have a good chance of finding a fulfilling and joyful sexuality. However, if the pain during sex has been present for a long time, women and their partners need patience until there is an improvement. Women often have an odyssey from one doctor to the next until their illness is correctly diagnosed. Treatment requires good interaction between different specialist disciplines.
Structure of the female reproductive organs
The pubic area or vulva can be seen from the outside in women. It consists of the mons pubis (mons veneris), the labia majora and the labia minora. The vulva also includes the vaginal vestibule and the clitoris (clitoris). Inside is the vagina and behind it the uterus and, symmetrically on both sides, the fallopian tubes and ovaries. During sexual arousal, glands on the inside of the vaginal entrance secrete a secretion that moistens the vagina. This allows the penis to glide better in the vagina during sexual intercourse. On the other hand, the secretion contains glucose, which provides the sperm with energy on its way to the egg.