Dyspareunia: generalities
The term "dispareunia" derives from the Greek words δυσ (difficulty) παρά (near) εÙνή (bed): it indicates a painful condition felt by the woman during sexual intercourse, near the area that affects the vagina; although mostly considered a female disorder, dyspareunia can also affect men, involving the genitals. However, generally the male disorder is caused by physical factors of another nature, such as bacterial infections and genital irritations, prostate enlargement, testicular diseases or short frenulum.
Incidence
It is estimated that dyspareunia affects 12-15% of women of childbearing age and about 45% of women in the post menopausal period: according to statistics, it is understandable how widespread dyspareunia is. Nevertheless, unfortunately, the disorder has been poorly considered by doctors in the past years; in any case, in recent years, dyspareunia has been the subject of research focused, mainly, on the possible predisposing factors.
Classification
The moment of onset of pain represents an absolutely indispensable element to classify dyspareunia: we speak of primary dyspareunia (also called lifelong ) when pain during penetration occurs from the beginning of sexual life, and of dyspareunia acquired when the disorder it occurs after a few years.
To classify dyspareunia, other parameters must be taken into account:
- Stress : a condition that often accompanies dyspareunia and hinders the life of a couple. Stress is rarely absent in women who complain of dyspareunia, since the difficulty in consuming the relationship is often a cause of anxiety and worries that are reflected in stress. Distress (as well as "negative" stress) could be mild, medium or severe, and affect dyspareunia differently.
- Symptom and context correlation : in some situations, the woman with dyspareunia may not have symptoms, in others, however, the pain could be so acute as to hinder any possible attempt at penetration. In the first case, it is a situational dyspareunia, whereby the woman perceives pain based on the partner and on the basis of the environment; there is talk of generalized dyspareunia, when the pain felt occurs in all relationships.
- Dyspareunia can also be classified on the basis of the nature of the underlying cause : in other words, causes (of psychogenic, organic, mixed or unknown origin) can direct the doctor in choosing the most appropriate treatment for the patient.
- Last but certainly not least, the location of pain (superficial, vaginal-vaginal and deep) is necessary to distinguish three different types of dyspareunia, which provide variable pain intensity based on the most sensitive area.
These last two parameters (nature of the causes and location of the pain), given their considerable incidence on dyspareunia, will be studied in depth.
Possible causes
Based on the characterization of the causes, dyspareunia can be classified into three categories: multisystem, multifactorial and complex. By " multi systemic " is meant a dyspareunia involving many systems (endocrine, peripheral and central nervous, muscular, vascular, immune); multifactorial dyspareunia, as the term itself already predicts, outlines a disease to which various factors are related (relational, psychological, sexual). Lastly, complex dyspareunia is a disorder of difficult interpretation in which several factors are mixed: it is a dyspareunia in which both the aspects analyzed in the multisystem and in the multifactor are included.
Pain localization
The study of the location of coital pain, and therefore of the site of its onset, is a factor of absolute importance for understanding the aetiology of dyspareunia: a correct analysis of the causes is useful to the doctor to understand the peculiar aspects of the disease; consequently it will be easier to diagnose and treat dyspareunia.
As already mentioned, dyspareunia can be introital (or superficial), middle-vaginal or deep: although the superficial and vaginal-middle dyspareunias are both perceived by the woman in the preliminary stage of the relationship, the two types are linked to different causal factors, although presenting many similarities. With regard to profound dyspareunia, however, both the symptoms and the causes are well differentiated from the previous ones.
The substantial difference between mid-vaginal and superficial dyspareunia lies in the "defensive" contraction of the levator ani muscle, typical of mid-vaginal dyspareunia and absent in the superficial. Both the above types of dyspareunia can be related to causes of a psychosexual, biological and relational nature.
- Psychosexual causes are favored by libido disorders, sexual harassment and violence, anxiety and depression. Often, three psychosexual causes that favor dyspareunia, multiple sexual disorders coexist, such as, for example, vaginismus, decreased excitement, the fall of desire, etc. Dyspareunia could also be triggered by some episodes of childhood: women who have been raped or sexually abused by young people tend to complain of sexual disorders even in adulthood and dyspareunia falls into this category.
- The biological trigger factors affecting superficial and vaginal dyspareunia can be infectious, hormonal, iatrogenic (caused by drugs), vascular, muscular and connective. Vaginal infections, such as candidiasis, could greatly affect penetration pain: Candida, in addition to causing dyspareunia, causes a known decrease in libido and excitement that is sometimes reflected in the partner.
- " Relational causes " refer essentially to a decrease in libido, problems with the partner and a marked sexual dissatisfaction.
Vulvar vestibulitis - the inflammation that affects the clitoris, vaginal entry and urethral orifice - certainly represents the prevalent etiological factor that predisposes to superficial and vaginal mid-vaginal dyspareunia.
Among the factors that cause profound dyspareunia, endometriosis, abdominal nerve entrapment syndrome, pelvic varicocele and PID (pelvic inflammatory disease) stand out: the causes listed above are considered biological factors, which can add to other causal elements and make them even more the relationship is painful.
Dyspareunia and pain
The location, the characteristics and the way in which the pain appears must be carefully evaluated by the specialist, in order to correctly diagnose the dyspareunia; consequently, they are also essential for planning the most appropriate therapy.
The degree of pain intensity is assessed by an ideal scale ranging from 0 to 10, in which "0" represents the minimum pain felt and "10" is the maximum degree, almost unbearable. Women with dyspareunia report their pain assessments in a folder, in which they are asked to indicate, approximately, the area and time of perception of the illness. Pain estimation is important to record sensitivity variability; in fact, women with dyspareunia often complain of variable pain, which increases and decreases according to the moments and situations.
Pain and related symptoms
The pain may continue even after intercourse, even up to a few days later: when this situation occurs, generally, more serious pathologies are associated such as, for example, vulvar vestibulitis.
Among the other symptoms associated with pain, we remind vaginal dryness (linked to possible excitation disorders or hormonal imbalance), vaginal pH alteration, intolerance to the use of internal swabs during the menstrual cycle, and perception of pain, associated with that of dyspareunia, during gynecological checkups.
Care
Psychological therapy aimed at resolving dyspareunia represents (perhaps) the most effective resolutive treatment, preferably without the use of drugs: it has been recorded that verbal, single and couple psychotherapy helps to "restore" the woman's thoughts and to dismantle his anxieties and worries, which very often negatively affect sex life.
Avoiding sexual intercourse, escaping from possible situations of intimacy with the partner and the excessive use of anxiolytic drugs, certainly do not help to solve the dyspareunia. Rather, the history of each individual patient must be scrupulously studied in order to remedy dyspareunia.
Key points
To fix the concepts ...
| Disease | Dyspareunia: painful condition felt by the woman during sexual intercourse, near the area that affects the vagina |
| Differences with vaginismus | Dyspareunia is a pain that is felt during intercourse, while vaginismus is the phobia of the possible pain generated by penetration |
Incidence | Very common disorder among women in the post-menopausal period (45% is affected); dyspareunia also affects 12-15% of women of childbearing age. Also a male disorder, but which only affects a small part of men. |
Classification |
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| Parameters affecting the type of dyspareunia |
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| Causes that cause dyspareunia |
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symptomatology | The pain caused by the relationship could last even a few days after having consumed the relationship; moreover: vaginal dryness, vaginal pH alteration, intolerance to the use of internal swabs during the menstrual cycle, and perception of pain even during gynecological checkups |
| Therapies for treating dyspareunia | Single and couple psychological therapy is probably the best resolution treatment |
