When sexual intimacy with your partner causes pain, it can have a deep psychological impact.  You may feel alone and uncertain where to turn.  Many will suffer in silence, as the topic can be difficult to discuss.  The pain can lead to a disinterest in sex and eventually you may avoid physical intimacy altogether with your partner.  Without treatment, the relationship may suffer.

Dyspareunia is defined as persistent or recurrent genital pain experienced with attempt of sexual intercourse.  It may be aching, burning, throbbing, or ripping in nature.   Though underreported, twenty percent of American women will seek treatment from doctors due to some form of pain during intercourse.

Types of Dyspareunia. Dyspareunia is classified as either superficial or deep.  Superficial dyspareunia refers to pain on the outside of the vagina, experienced upon contact or attempted penetration; while deep dyspareunia refers to pain experienced inside the vagina or pelvis associated with deep penetration or thrusting.  It is possible to have a combination of the two, as some conditions incite irritation or inflammation of nerves and muscles within the pelvis.  These complex presentations will likely require expert evaluation to thoroughly diagnose and treat.

What Causes the Pain? The key to getting rid of the pain is to first identify exactly what’s happening and where, as the location of the pain helps to determine its cause. Superficial pain may be linked to any of the following: intermittent or chronic vaginitis caused by infection or candida; vaginal atrophy due to low hormone levels; chronic inflammation caused by conditions such as lichen sclerosis; irritation due to allergens and skin sensitivities; scarring after trauma (childbirth, genital mutilation, assault, radiation); large or loose labia, or size differences between the erect penis and vaginal opening.

Pain deeper in the vagina may require extensive testing to reach diagnosis.  Conditions to be considered include: vaginismus and pelvic muscle spasms; painful bladder conditions (interstitial cystitis); gynecological conditions (endometriosis, fibroids, ovarian cysts); pelvic organ changes (prolapsed bladder or uterus), and previous pelvic surgeries (hysterectomy, mesh placement).

Because the natural changes of aging have dramatic effects on vaginal tissue and lubrication, vulvovaginal atrophy is the leading cause of dyspareunia in women over age 50.

Treatment Options. Getting back to pain-free sex may involve multiple treatments based on the underlying cause.

If no infection or injury is identified, simple solutions may begin with using silicone-based lubricants, bio-identical hormone replacement, vaginal dilators, or position changes. Some conditions may improve with laser vaginal rejuvenation, a safe office procedure that restores the integrity of the vaginal tissue. More complex problems may require other options such as pelvic floor physiotherapy, surgical procedures, or counseling services. 

If you are experiencing painful sex, it is important to seek help early.  Finding an experienced doctor with whom you feel comfortable discussing your concerns will ensure the best outcome. 

Intimacy is an important part of life, and you deserve to have a fulfilling sex life that is all pleasure and no pain.

Dr. Bogard is a board-certified gynecologist specializing in intimate wellness, advanced hormone optimization, and aesthetic vaginal reconstruction.  She serves as the Medical Director of the Intimate Wellness Institute in Palm Springs and can be reached at (760) 904.4994. www.IWIPalmSprings.com

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