Sex Without Suffering ..... Treating Dyspareunia Sexual intercourse causes physical pain for many women. The good news is that this condition, called dyspareunia, is often treatable. Women suffering from dyspareunia should realize that they aren't alone. Many women have painful intercourse at some time in life. Although such experiences may occur only rarely, some women may experience pain every time they have intercourse. In fact, some women suffer so badly that they have never been able to use tampons. The important thing to remember, however, is that there is hope - and help that is availble. It begins with understanding a little about what is happening to your body when sex hurts - and what you can do . What Causes Dyspareunia? 1. Inadequate lubrication. Lack of lubrication is the most common cause of dyspareunia. For some women, this will improve with increased arousal before intercourse, but some women just don't produce enough natural vaginal lubrication .In middle-aged women, the hormonal changes of menopause may lead to atrophic vaginitis (thinning of the vaginal lining), another cause of inadequate lubrication and, in turn, dyspareunia. In addition, lubrication levels decrease naturally with aging. Vaginal dryness may also be a side effect of certain medications (such as the cancer drug tamoxifen). New mothers should be aware that vaginal dryness sometimes develops because of the hormonal changes of breast-feeding.Irritation or inflammation of the vaginal area. There are several causes of irritation and inflammation of genital and vaginal area, such as skin diseases, vulvar vestibulitis (a condition causing inflammation at the opening of the vagina) and allergic reactions to underclothing, spermicides or douches.Infection. 2. Infections Certain infections (vaginal yeast infections, urinary tract infections and sexually transmitted diseases) may cause dyspareunia, although in most cases, other symptoms, such as burning with urination or vaginal discharge, are also present. 3.Endometriosis. Endometriosis, a condition in which fragments of the uterine migrate to the abdominal cavity, may cause pelvic pain and dyspareunia. 4. Sexual abuse or trauma. Some women suffer from dyspareunia because of a history of sexual abuse or trauma. These women often experience vaginismus -- severe vaginal spasms with intercourse -- a cause of dyspareunia. If you are in this situation, it's important to realize this response is your body's attempt to protect you from harm. What Are The Symptoms? In cases in which there is inadequate vaginal lubrication, penetration is often accompanied by a sensation of dryness and friction. With continued penile thrusting, lubrication may be produced. But because the vaginal lining is already irritated, intercourse is often uncomfortable. This pain may continue for hours to days afterwards. Women with vaginal yeast infections or genital lesions from warts or herpes will usually feel pain with touch. If the external genitals are involved, the pain is often superficial, but if the cervix is inflamed, deeper penetration often causes discomfort. Urinary tract infections typically cause continuous discomfort, but the severity increases with sexual intercourse because of the proximity of the vagina to the inflamed bladder. Skin diseases cause pain with touch because the skin is dry, cracked, irritated and sometimes scarred. Painful sores may be present in the vaginal opening. Vulvar vestibulitis causes pain in the area around the vaginal opening. Without treatment, the symptoms can last for years. Patients with endometriosis can also have long-standing symptoms. The pelvic pain is often constant, sometimes lasting for days at a time, and intercourse may make it more severe. How Is Dyspareunia Diagnosed? Although you may feel embarrassed about discussing sexual issues with your doctor, it's important to mention whether you experience dyspareunia, because there are many possible treatments available. Your doctor can assess your symptoms and attempt to identify the cause of your discomfort. Typical questions include: ·Where is your pain? Does it hurt to touch your genitals, or does the pain occur only with penetration or thrusting? The location of your pain is an important clue to the cause of your symptoms. Superficial pain may be caused by an infection or an allergic reaction, whereas deeper pain may be caused by a lack of lubrication, a cervical infection or a history of sexual abuse or trauma. · Is your natural lubrication adequate? Do your symptoms improve with commercially available lubricants? · Have you ever had painless intercourse, or have you always suffered from dyspareunia? Long-standing symptoms suggest a chronic problem, such as insufficient natural lubrication, or psychological discomfort stemming from a history of sexual abuse or trauma. Acute symptoms, lasting days to weeks, are more typical of physical causes, such as infection or disease or a side effect from a new medication. · Are you experiencing irregular periods, hot flashes or vaginal dryness? These symptoms suggest that you may have atrophic vaginitis related to the hormonal changes of menopause Your Physical Exam . Your doctor will typically perform a physical examination, including a pelvic exam, to help determine the cause of your symptoms. He or she will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), scarring, abnormal pelvic masses or tenderness. What Can You Do About Dyspareunia? Treatment often involves treatment of the underlying cause. For example, an over-the-counter vaginal lubricant may be helpful if vaginal dryness is the cause of your dyspareunia. Antibiotic, antifungal or antiviral drugs may help relieve dyspareunia caused by a bacterial, yeast or viral infection. Long-term cortisone creams may be useful if a skin disease (such as lichen planus or lichen sclerosis) is the cause of your symptoms. Atrophic vaginitis will rapidly improve with estrogen therapy. Endometriosis can be treated with hormonal or surgical therapy. Vulvar vestibulitis can be difficult to treat, but it often improves with topical estrogen cream, low-dose pain medications and physical therapy with biofeedback to lower the muscle tension in the pelvic floor. Long-standing symptoms of dyspareunia caused by sexual trauma or abuse typically take longer to treat, but they often improve with counseling .From: Serena Koenig, M.D., an instructor in medicine at Harvard Medical School, and on the faculty of the Department of General Medicine at Brigham and Women's Hospital. She is also the director of medical communications in the Program in Infectious Disease and Social Change at Harvard Medical School. For more information visit www.Intelihealth.com |
Intimate Health Care For Women |
Sex Without Suffering ..... Treating Dyspareunia Sexual intercourse causes physical pain for many women. The good news is that this condition, called dyspareunia, is often treatable. Women suffering from dyspareunia should realize that they aren't alone. Many women have painful intercourse at some time in life. Although such experiences may occur only rarely, some women may experience pain every time they have intercourse. In fact, some women suffer so badly that they have never been able to use tampons. The important thing to remember, however, is that there is hope - and help that is availble. It begins with understanding a little about what is happening to your body when sex hurts - and what you can do . What Causes Dyspareunia? 1. Inadequate lubrication. Lack of lubrication is the most common cause of dyspareunia. For some women, this will improve with increased arousal before intercourse, but some women just don't produce enough natural vaginal lubrication .In middle-aged women, the hormonal changes of menopause may lead to atrophic vaginitis (thinning of the vaginal lining), another cause of inadequate lubrication and, in turn, dyspareunia. In addition, lubrication levels decrease naturally with aging. Vaginal dryness may also be a side effect of certain medications (such as the cancer drug tamoxifen). New mothers should be aware that vaginal dryness sometimes develops because of the hormonal changes of breast-feeding.Irritation or inflammation of the vaginal area. There are several causes of irritation and inflammation of genital and vaginal area, such as skin diseases, vulvar vestibulitis (a condition causing inflammation at the opening of the vagina) and allergic reactions to underclothing, spermicides or douches.Infection. 2. Infections Certain infections (vaginal yeast infections, urinary tract infections and sexually transmitted diseases) may cause dyspareunia, although in most cases, other symptoms, such as burning with urination or vaginal discharge, are also present. 3.Endometriosis. Endometriosis, a condition in which fragments of the uterine migrate to the abdominal cavity, may cause pelvic pain and dyspareunia. 4. Sexual abuse or trauma. Some women suffer from dyspareunia because of a history of sexual abuse or trauma. These women often experience vaginismus -- severe vaginal spasms with intercourse -- a cause of dyspareunia. If you are in this situation, it's important to realize this response is your body's attempt to protect you from harm. What Are The Symptoms? In cases in which there is inadequate vaginal lubrication, penetration is often accompanied by a sensation of dryness and friction. With continued penile thrusting, lubrication may be produced. But because the vaginal lining is already irritated, intercourse is often uncomfortable. This pain may continue for hours to days afterwards. Women with vaginal yeast infections or genital lesions from warts or herpes will usually feel pain with touch. If the external genitals are involved, the pain is often superficial, but if the cervix is inflamed, deeper penetration often causes discomfort. Urinary tract infections typically cause continuous discomfort, but the severity increases with sexual intercourse because of the proximity of the vagina to the inflamed bladder. Skin diseases cause pain with touch because the skin is dry, cracked, irritated and sometimes scarred. Painful sores may be present in the vaginal opening. Vulvar vestibulitis causes pain in the area around the vaginal opening. Without treatment, the symptoms can last for years. Patients with endometriosis can also have long-standing symptoms. The pelvic pain is often constant, sometimes lasting for days at a time, and intercourse may make it more severe. How Is Dyspareunia Diagnosed? Although you may feel embarrassed about discussing sexual issues with your doctor, it's important to mention whether you experience dyspareunia, because there are many possible treatments available. Your doctor can assess your symptoms and attempt to identify the cause of your discomfort. Typical questions include: ·Where is your pain? Does it hurt to touch your genitals, or does the pain occur only with penetration or thrusting? The location of your pain is an important clue to the cause of your symptoms. Superficial pain may be caused by an infection or an allergic reaction, whereas deeper pain may be caused by a lack of lubrication, a cervical infection or a history of sexual abuse or trauma. · Is your natural lubrication adequate? Do your symptoms improve with commercially available lubricants? · Have you ever had painless intercourse, or have you always suffered from dyspareunia? Long-standing symptoms suggest a chronic problem, such as insufficient natural lubrication, or psychological discomfort stemming from a history of sexual abuse or trauma. Acute symptoms, lasting days to weeks, are more typical of physical causes, such as infection or disease or a side effect from a new medication. · Are you experiencing irregular periods, hot flashes or vaginal dryness? These symptoms suggest that you may have atrophic vaginitis related to the hormonal changes of menopause Your Physical Exam . Your doctor will typically perform a physical examination, including a pelvic exam, to help determine the cause of your symptoms. He or she will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), scarring, abnormal pelvic masses or tenderness. What Can You Do About Dyspareunia? Treatment often involves treatment of the underlying cause. For example, an over-the-counter vaginal lubricant may be helpful if vaginal dryness is the cause of your dyspareunia. Antibiotic, antifungal or antiviral drugs may help relieve dyspareunia caused by a bacterial, yeast or viral infection. Long-term cortisone creams may be useful if a skin disease (such as lichen planus or lichen sclerosis) is the cause of your symptoms. Atrophic vaginitis will rapidly improve with estrogen therapy. Endometriosis can be treated with hormonal or surgical therapy. Vulvar vestibulitis can be difficult to treat, but it often improves with topical estrogen cream, low-dose pain medications and physical therapy with biofeedback to lower the muscle tension in the pelvic floor. Long-standing symptoms of dyspareunia caused by sexual trauma or abuse typically take longer to treat, but they often improve with counseling .From: Serena Koenig, M.D., an instructor in medicine at Harvard Medical School, and on the faculty of the Department of General Medicine at Brigham and Women's Hospital. She is also the director of medical communications in the Program in Infectious Disease and Social Change at Harvard Medical School. For more information visit www.Intelihealth.com |
