Dyspareunia: Causes, Diagnosis, and Modern Management

                           Dyspareunia: Causes, Diagnosis, and Modern Management

Introduction

Dyspareunia refers to persistent or recurrent pain during sexual intercourse that causes physical discomfort, emotional distress, or relationship difficulties. It is a common yet underreported condition affecting women of all ages and, less commonly, men. Despite its prevalence, many individuals suffer in silence due to embarrassment, cultural stigma, or lack of awareness that effective treatments exist.

Understanding dyspareunia is essential for early diagnosis, appropriate management, and improved quality of life.

Definition

Dyspareunia is defined as genital pain associated with sexual activity, occurring before, during, or after intercourse. The pain may be superficial (at the vaginal opening) or deep (within the pelvis).

Types of Dyspareunia

1. Superficial Dyspareunia

Pain occurs at the vaginal introitus during penetration. Common causes include:

• Vulvovaginal atrophy

• Vulvodynia

• Infections (e.g., candidiasis)

• Inadequate lubrication

• Vaginismus

2. Deep Dyspareunia

Pain is felt deep inside the pelvis, often during deep penetration. Causes include:

• Endometriosis

• Pelvic inflammatory disease (PID)

• Uterine fibroids

• Ovarian cysts

• Pelvic adhesions

Causes of Dyspareunia

Gynecological Causes

• Vaginal dryness (especially postmenopausal or lactating women)

• Endometriosis

• Pelvic infections

• Pelvic organ prolapse

• Congenital vaginal anomalies

Hormonal Causes

• Hypoestrogenism

• Menopause

• Use of hormonal contraceptives

Psychological Causes

• Anxiety or fear of intercourse

• History of sexual trauma

• Depression

• Relationship conflicts

Medical and Surgical Causes

• Previous pelvic surgery

• Radiation therapy

• Chronic medical conditions (e.g., diabetes)

Clinical Presentation

Patients may report:

• Burning, stabbing, or aching pain

• Pain only during penetration or deep thrusting

• Post-coital pelvic pain

• Reduced libido

• Emotional distress or avoidance of intimacy

Diagnosis

History Taking

A thorough and sensitive sexual and medical history is crucial, focusing on:

• Onset, location, and severity of pain

• Menstrual and obstetric history

• Psychological and relationship factors

Physical Examination

• Inspection of vulva and vagina

• Gentle bimanual examination

• Pelvic floor muscle assessment

Investigations

• Vaginal swabs

• Pelvic ultrasound

• MRI (when endometriosis is suspected)

• Diagnostic laparoscopy in selected cases

Management of Dyspareunia

Medical Treatment

• Topical estrogen therapy

• Lubricants and vaginal moisturizers

• Antibiotics or antifungals (if infection present)

• Hormonal therapy

Physical Therapy

• Pelvic floor physiotherapy

• Biofeedback techniques

Psychological Support

• Cognitive behavioral therapy (CBT)

• Sex therapy

• Couples counseling

Surgical Management

• Treatment of underlying pathology such as endometriosis or fibroids

Prevention and Patient Education

• Early treatment of vaginal infections

• Adequate lubrication during intercourse

• Open communication with partners

• Regular gynecological follow-up

When to See a Doctor

Medical consultation is recommended if:

• Pain persists or worsens

• Intercourse becomes impossible

• Pain affects mental health or relationships

Conclusion

Dyspareunia is a treatable medical condition, not something to be tolerated in silence. A multidisciplinary approach addressing physical, hormonal, and psychological factors offers the best outcomes. Raising awareness and encouraging open discussion can significantly improve patient well-being and sexual health.