Pain During Intercourse- Dyspareunia

It is quiet a serious problem, which hampers a woman's personal and family life. In most cases this become a vicious cycle and anticipation of pain during intercourse lead to more spasm., less arousal and lubrication and more tense muscles and more pain!

Vaginismus is one condition where no pathology is found, and it is a psychological condition which leads to the spasm of the muscles and pain. She must be counseled properly and help of a sex therapist is required.

Few reasons of vaginismus are:

• Sexually abused sometimes in her life
  
• She is taught that sex is immoral, vulgar, or demoralizing
  
• Fear of pain associated with penetration, particularly rupture of hymen in first intercourse.
  

In other forms of dyspareunia, pathology, some form of disease is found. This may be superficial or, deep type.

Superficial dyspareunia – reasons and treatment:

Superficial or introital dyspareunia occurs due to

• Dryness of vagina, lack of arousal – Oestrogen cream may help.
  
• Infection and or, ulcers, fungal or bacterial in the vagina or vulva. – To be treated by proper antibiotics or antifungal.
  
• Narrow introitus: surgical correction will be required
  
• Painful scar during previous delivery in the vulval region: painful scar may be removed if necessary. Local anaesthetic cream also helps.
  

Deep dyspareunia:

Here the pain felt deep inside during the thrust of intercourse.

The reasons and treatment of deep dyspareunia are:

• Endometriosis and pelvic infection – Treatment of the respective cause
  
• Ovaries may be placed at abnormal position mostly in the pouch of douglas, below and behind the uterus, where it is hurt during the thrust – Change of posture during sexual act or, corrective surgery (ventrosuspension), if necessary will solve the problem.
  
• Dermatographism: A condition where a linear wheal is formed with surrounding red flare anywhere on the skin after a firm stroke. The reason is unknown. This may be a rare cause of dyspareunia, where itchy wheals formed on the vulva. These can be relieved by application of 2% epinephrine cream and anti allergic tablets like cetrizine.

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