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Painful Sexual Intercourse or Dyspareunia in women is a common experience though hardly talked about. This piece, talks about its causes and cure.
Dyspareunia is defined as painful sexual intercourse. It is a fallacy that dyspareunia afflicts only women. Not so. Men could also suffer from it –which might not be known beforehand, in a society as prone to secrecy on sexual matters and favouring arranged marriages, often leading to non-consummation of a marriage.
A scholarly study revealed that about 23% to 55% of women suffered from dyspareunia in various degrees. Due to its very nature, it is a problem often not recognized as a treatable disorder and grossly underreported. Women would rather suffer in silence, under wrappings of shame, a fear of social mortification, and an inability to articulate their pain even to the intimate partner. It could lead to a serious lack of self-esteem, depression, as also secondary infertility – an inability to conceive due to a lack of sexual relations. This takes a toll on them psychologically, physically, and relationships can get corroded. Also, the social and economic costs of underlying disorders like endometriosis, ovarian cysts, uterine fibroids, etc. (discussed later) could be huge.
So the need is to break that silence.
Men’s dyspareunia is beyond the scope of this article. We shall look only at dyspareunia as it affects women.
There are two types — superficial dyspareunia (pain at the vaginal opening or just inside felt even with minimal penetration), and deep dyspareunia (pain on deep thrusting, felt ‘inside’). Depending on this, the causes and treatment differ.
This could be due to a host of factors, which while not as serious medically as in deep dyspareunia, can be equally distressing.
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This informative article will detail the following aspects of painful sex (Dyspareunia) in women:
Vaginal dryness: Often caused due to hormonal conditions in the second half of the menstrual cycle, around menopause, or in older women. Mostly, though, this could be due to a lack of arousal in women, a factor which is often not taken into consideration. The causes could be a lack of education or apathy of the partner about sexual arousal, or complex psycho-social factors.
Vaginismus: This is an involuntary constriction of the peri-vaginal muscles at the attempt to penetrate, or sometimes even at the thought of sex. It is a conditioned reflex, one that might be brought about by a fear of sex. There might be a history of sexual abuse, a memory of a painful first intercourse, frightening medical procedures in childhood, or a fear of pregnancy. It could be due to a lack of a feeling of ownership over her own body or sexual organs, in some patriarchal or abusive social conditions. It could be sexual inhibition, of religious origin or a strong social conditioning about being a good girl.
Vulval/vaginal dermatitis and infections: There can be many other infections or skin conditions that can affect the vulva (the visible part of the female genital anatomy, lined with a mucosal membrane instead of the usual skin), and may present differently than on other parts of the body, and a visit to the gynaecologist or even a dermatologist can diagnose it. Vulval/vaginal infections that are borne for too long, out of shame or a lack of knowledge, can infect the uterus, fallopian tubes, etc., escalating into full blown pelvic inflammatory disease, with further complications.
Injury: Often from a previous childbirth, that might not have healed well. It could also be an accidental injury, or injury during forceful sex, which might become painful for a few days. Often this kind of injury can irritate the urethra, leading to recurrent urinary infections, which leads to dyspareunia.
Endometriosis: Inflammation of the lining of the uterus, presenting mainly with severe dysmenorrhoea – heavy and painful periods.
Pelvic inflammatory disease (PID): Infection anywhere in the female genital organs – vagina, cervix, uterus, fallopian tubes, or ovaries. Untreated, this could have serious consequences, and should never be ignored.
Ovarian cysts: Cyst formed in the space left behind after an egg is released. It may remain asymptomatic (in which case it can be left alone), or become painful if it grows in size, gets infected, or bleeds inside.
Urinary tract infections: The bladder and urethra being in such close proximity to the uterus and vagina, they can get irritated on deep thrusting leading to pain. Passing urine after sex can also become excruciatingly painful.
Uterine prolapse: In older women who have given birth, sometimes the tissues and ligaments holding the uterus in place weaken, leading to a prolapse on coughing, laughing, or straining.
Retroverted uterus: Improper placement of the uterus.
Uterine fibroids: Large fibrous masses inside the muscles of the uterus.
Other conditions include irritable bowel syndrome, haemorrhoids, etc. Sometimes it could be a tumour of any of the pelvic organs, benign or malignant. Sometimes, the cause could be internal scarring after a surgery in the pelvic or abdominal region that gets jarred, or very rarely, the aftereffects of radiation therapy or chemotherapy, often affecting different organs in unpredictable ways.
Firstly, consent is important. Forcible sex can almost always lead to dyspareunia, even in long-term partners.
Break that silence. Talk to someone. If possible, to the partner. If not, tell a trusted family member/friend.Visit your gynaecologist. Ask them if you need to consult a dermatologist or counsellor. Do not feel shy about describing your symptoms.
Even if you recognize that the problem might be just dryness, tackled by using a suitable lubricant, it might be worthwhile to correct any possible hormonal imbalances.
Get your partner and yourself an education – of the sexual kind. Discuss what you like. Books help. Visit a counsellor if necessary. Marital counselling is advisable. You certainly need some TLC if it is vaginismus. Changing sexual positions might help – a woman on top approach gives you a modicum of control over how deep the thrusting can go. Find other ways of pleasuring.
The underlying disorders need to be addressed, as some of them can be completely cured, and withholding treatment on account of inability to speak about it can lead to many complications with long-term morbidity. Getting rid of the dyspareunia is certainly a plus.
Woman in pain image via Shutterstock
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