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Meaning and remedies of dyspareunia

By Cristiano Antonino On Jun 20, 2022

Dyspareunia is genital pain that is felt during sexual intercourse. It is a disabling gynaecological problem that affects approximately 10-20% of women, with peaks of up to 40% after menopause and a profound impact on the sexual life of those affected

What is dyspareunia and how is it classified

The term dyspareunia indicates a condition of pain in the female vaginal area during sexual intercourse and, specifically, during penetration.

The disorder can be classified in several ways, including:

superficial dyspareunia: pain during penetration is localised, as the word implies, in the superficial area, at the level of the vaginal orifice (vulvar introitus) or in the first part of the vagina;
deep dyspareunia: pain following full vaginal penetration is evidenced in the deep vaginal area and in the pelvic cavity, i.e. the lower section of the abdomino-pelvic cavity
mixed dyspareunia: includes both of the previous types.

Another distinction that can be made is between:

primary dyspareunia: pain occurs from the very beginning of a person’s sexual life;
secondary dyspareunia: the pain occurs later (the person’s sexual life was previously normal).

Finally, one can also distinguish between

generalised dyspareunia: present continuously and constantly;
situational dyspareunia: present only in certain situations and with certain partners.

Determining the type of dyspareunia is essential in order to formulate a hypothesis of the underlying causes of the problem.

At what age does dyspareunia occur?

Dyspareunia can occur at any age, but has a higher incidence particularly after menopause (up to 40 per cent of menopausal women), due to a reduction in oestrogen levels leading to a loss of tissue elasticity and increased vaginal dryness.

The symptoms

In addition to pain during penetration and sexual intercourse, the symptoms that patients with dyspareunia may present and that are often related to the causes of the disorder are:

vaginal dryness and poor lubrication;
redness, itching and/or swelling in the vulvo-vaginal area;
bleeding outside of the menstrual cycle;
irregularity of the menstrual cycle;
vaginal lesions;
vaginal discharge with a foul odour;
pain during urination (dysuria).

Physical causes of dyspareunia

The causes of dyspareunia can be very varied and belong either to the psychological or the physical sphere.

In the first case, we speak, for example, of traumas encountered in the sexual sphere (abuse, violence, too restrictive upbringing, etc.) or anxiety/stress that can lead to a general tension also at the muscular level.

The physical sphere, on the other hand, includes a series of anatomical-functional problems and pathologies that also differ according to the various forms of the disorder. Let us look at them in detail.

The causes of superficial dyspareunia

The form of dyspareunia localised in the superficial area and at the beginning of the vaginal canal can, for example, be caused by

vaginismus, i.e. an involuntary contraction, which creates a physical obstacle to penetration, by the elevator muscle of the anus, i.e. the load-bearing structure of the pelvic floor that supports the organs of the cavity and ensures urinary and faecal continence;
vulvodynia, i.e. chronic pain, in some cases referred to as burning, in the vulvar area that persists for more than 6 months;
dermatological diseases, including, for example, lichen, an irritative disease, characterised by dryness of the skin and frequently also by whitish hyperkeratotic areas in the vulvar area.

Causes of deep dyspareunia

Among the most common causes of deep dyspareunia are

endometriosis: extrauterine presence of endometrium, the tissue that generally only lines the uterine cavity;
genito-pelvic infections, e.g. endometritis, i.e. infection/inflammation of the endometrium, cystitis, pelvic inflammatory disease (PID), which is a bacterial infection of the female genital apparatus;
interstitial cystitis: chronic inflammation of the bladder due to as yet unknown causes;
pelvic adhesion syndrome, i.e. pain in the pelvic area most often due to the after-effects of surgery or radiotherapy;
retroverted uterus: the uterus, instead of presenting in the normal position, assumes a backward-facing position;
uterine fibroids: also called uterine myomas or leiomyomas, these are benign tumours consisting of muscle and fibrous tissue that form in the uterus;
radiculopathies: pathologies affecting one or more spinal roots, in this case responsible for the deep innervation of the vagina, most often due to their compression.

The causes of the mixed form

Finally, talking about a possible aetiology of the mixed form, one should mention vaginal atrophy (or dystrophy), which indicates a thinning of the tissues and mucous membranes in the vagina, which can lead to chronic dryness in this area.

It is a problem that affects about 40% of menopausal women due to a reduction in oestrogen levels, but can also occur due to disorders, e.g. hormonal, vascular, neurological, autoimmune diseases and certain types of therapies.

Diagnosis

The diagnosis of dyspareunia is first made through a thorough gynaecological and general anamnesis followed by a bimanual examination and a transvaginal ultrasound scan that can also detect the presence of any physical causes.

Treatment and remedies for dyspareunia

Patients suffering from dyspareunia must be assessed individually, so for each one it is necessary to make her feel comfortable and to establish a personalised therapy, which in many cases can also be multidisciplinary.

If necessary, the doctor may also prescribe the use of certain drugs, such as, for example

local and systemic antibiotics to treat an infection of bacterial origin;
antimycotics in the presence of fungal infections;
oestrogens in cases of vaginal atrophy;
sedatives and muscle relaxants to act on muscle contractions;
anti-inflammatories, also in the case of allergies, when, even if the substance that caused the reaction is stopped, the symptoms associated with it persist.

In addition, some practical tips for managing dyspareunia may be: