Dyspareunia (dys*pa*reu*nia) means painful sexual intercourse. The pain can occur with initial penetration and/or during thrusting and/or after intercourse (an after-effect).
Painful sex, or dyspareunia, is defined by dividing the presenting symptomology into three categories: onset, frequency, and location:
- Onset asks about the start of the problem: Has it been there since the first time intercourse was attempted (primary or lifelong dyspareunia), or did it start after a period of having normal intercourse (secondary or acquired dyspareunia)?
- Frequency examines whether the problem occurs with all partners and in all penetrative situations (complete or generalized dyspareunia), or only at times, with certain partners, in certain positions, or because of certain circumstances (situational dyspareunia).
- Location describes whether the pain is upon initial penetration at the vaginal opening (insertional or superficial dyspareunia) or during thrusting and full penetration (deep dyspareunia).
Putting it all together, since painful sex may present itself in different combinations, a thorough assessment is imperative to identify the particular type of dyspareunia the woman has. Typical variations may include:
- Primary, situational, deep: thrusting always hurts while the woman is in a specific intercourse position (missionary, or woman-on-top, or side-by-side, etc.); other positions are okay;
- Secondary, situational, insertional: experiences pain with a current partner upon the beginning of penetration, but it goes away as soon as the man’s penis is halfway in; never happened with prior partners; pain is not as bad during the menstrual cycle;
- Primary, complete, superficial, and deep: the woman has always experienced pain, with all partners, in all positions, throughout the sexual act;
- Secondary, complete, superficial: initial penetration has been painful since a disruptive life event (surgery, childbirth, injury, etc.) regardless of sexual position, use of lubrication, choice of partner.
Unfortunately, many women are putting up with painful intercourse, depriving themselves of healthy intimacy, which should be the cornerstone of any relationship. Women rarely seek medical assistance to discuss sexual difficulties, a fact that makes it impossible to assess the prevalence of dyspareunia (and vaginismus, for that matter). The two main reasons behind this reluctance are women’s tendency to accept pain as an inevitable part of intercourse and worry that the clinician will ridicule them or dismiss their complaints as “being crazy.” On the other hand, the sad truth is that not all clinicians are attuned to this condition’s nature or presence, nor are they comfortable discussing such intimate matters. Although there have been gains in this direction in recent years, taking a thorough, detailed sexual history at the doctor’s visit is still not the standard of care.
- Medical causes, such as vaginal infections, sexually transmitted diseases, skin conditions, hormonal problems, conditions of the intestines or genitals or urinary system
- Physical causes, such as vaginal abrasions, scars, nerve damage, complications from vaginal delivery, size incompatibility
- Functional causes, such as genital irritation due to excessive hygiene or sensitivity to cleansing agents, poor hygiene, friction irritation due to sports such as cycling or horseback riding, insufficient vaginal lubrication
- Psychophysical causes, such as vaginismus, postpartum crisis, interpersonal difficulties, forced sexual encounters.
- Breast cancer
- Female (gynecologic) Cancer
- Sjogren’s Syndrome
Learn about our proprietary treatment for sexual pain, the DiRoss Methodologysm
Naturally, when intercourse is painful, the woman will want to avoid the act. Furthermore, she may also decline outercourse (non-penetrative sex, such as oral or manual) because she does not want to be reminded of the pain, disappointing the partner, or worried that he will sneak into her vagina. Another major avoidance is being totally shutdown sexually – a common coping mechanism of women that does not take much to develop.
From a psychophysical point of view, let us be reminded that intercourse is about the penis entering the woman’s body — being the “do-er” to her being ‘done to’ — and, therefore, it has to be invited and welcomed into her vagina when her body and mind are in sexual balance.
Painful sex (dyspareunia) can be a source of great conflict and anxiety to the woman who suffers from it, causing marked distress and interpersonal difficulties. Although intercourse is possible, the accompanying pain has been associated with a more negative attitude toward sexuality, more sexual function impairment, and lower levels of sexual adjustment. By putting up with painful intercourse, women are depriving themselves of the healthy intimacy that is the cornerstone of a happy relationship.
- A thorough assessment is imperative to identify the woman’s particular type of dyspareunia and offer the appropriate intervention. The clinician who takes the time to obtain a complete and careful medical, emotional, and sexual evaluation can help resolve most of these problems.
- The partner doesn’t need to come along for the sessions unless otherwise instructed.
- The treatment itself is about 2-7 sessions depending on the cause, and rarely more than 10 sessions.
- Read our Insurance page for instructions on how to get reimbursed for the treatment.
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