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Physical factors:
Superficial pain
Abnormalities from birth:
- absence of vagina;
- septum [sheet of tissue across the vagina]
- abnormal narrowing of the vagina.
- strand of hymen stretching across the opening to the vagina, or very thick hymen [both can be removed by surgery]
- vulvar vestibulitis syndrome [VVS]: means redness of the labia and pain and burning only with touch or pressure. Women with VVS are more sensitive to pain compared to other women [4]
- vulvodynia: chronic burning, stinging, irritation of the vulva while there is no infection or skin disease, pain may occur without contact, and be constant or intermittent, and localized or over the whole area of the vulva
- infections: thrush, herpes, boils, and cystitis [inflammation of the bladder]
- vaginismus: involuntary contraction of the muscles of the outer third of the vagina making penetration during intercourse painful or impossible
- scarring after surgery [episiotomy following childbirth]
- thinning of the vaginal walls after radiotherapy or menopause
- male factors: Peyronie’s disease or chordee during erection the penis is curved and can cause discomfort to the partner during entry into the vagina [see Pain During Sex in Men]
- rectal factors: internal haemorrhoids [piles], severe constipation or inflammation around the anus.
- acute or chronic illness: disability, chronic fatigue or chronic pain may impair libido and cause lack of arousal, and result in discomfort during intercourse because vaginal lubrication is inadequate, and this can result in vaginismus [pain at the entrance to the vagina]. Diabetes can cause redness and burning of the vulva.
Gynaecological factors: cyst or tumour of the ovary or uterus [fibroid] endometriosis, salpingitis [inflammation of the tubes], prolapse of the uterus [womb] into the vagina.
General:
- back pain or arthritis: pain may be increase by movement during intercourse
- cardio-vascular disease: if a person suffers from angina, intercourse may precipitate chest pain.
- contraceptives: oral [OC] or injectable [IC] contraceptives: may be associated with diminished lubrication, causing discomfort during intercourse. Ultra- low OCs reduce this problem. Diaphragm cap: may cause discomfort if too large or not properly in place. Intra-uterine device [IUCD]: pain may occur if there is an infection, or if the IUCD is too large or not properly in place. Spermicides: or douching with chemicals or perfumed soaps, or sensitivity to vaginal sprays or deodorants may cause irritation and burning.
- drugs: tranquillizers, or medicines for high blood pressure, or sleeping pills and anti-histamines can impair desire and arousal, and in turn reduce vaginal lubrication, and result in discomfort during intercourse [1].
- guilt: [about pre- or extra-marital sex]; fear of: intimacy/ sex/pain/pregnancy or penetration; memory of: sexual assault/molestation/forced sex; punishment for: masturbation/sex play; inhibited upbringing; religious taboos; and ignorance about sex and body functions can initiate dyspareunia or make it worse[1]
- relationship factors: conflict, stress, lack of privacy; poor communication, lack of affection or hostility, and hurried /inadequate/ineffective foreplay provides minimal stimulation and inadequate lubrication which may result in burning with penetration and thrusting, causing diminished arousal, which can make the dyspareunia worse, and then even anticipation of sexual contact can lead to avoidance, and can result in sexual aversion or vaginismus. Dyspareunia can cause distress and frustration and lead to non consummation and infertility, and in many cases to breakdown of the relationship. They may become confused, saying they love one another but the ‘patient’ freezes when touched by her partner.
- lack of understanding: about sex, and anticipation of pain due to myths about pain with sex
- pressure: from family and friends for a baby when the relationship has not been consummated leading to stress, anxiety and pressure to perform.
Sexual Responses: whatever the original cause, discomfort or pain is maintained or increased by the woman pulling in her thighs, guarding and tension of the muscles around the vagina, and this also inhibits pleasurable arousal.
Libido is usually fine initially but may gradually diminish, because of impaired arousal and tension with intercourse. This may set up a vicious circle of: pain-fear of pain-tension [which blocks sexual arousal]-excuses-sexual dysfunction resulting in sexual avoidance. Avoidance may extend to every day contact and lead to feelings of guilt, anger and rejection, all of which are anti-erotic.
Even when one partner has dyspareunia many couples learn to make love by mutual stimulation to orgasm and are comfortable with their lovemaking provided there is no attempt at penetration [2]
Failure to treat dyspareunia in a woman may result in vaginismus or sexual aversion [see: Sexual Aversion] and can cause her partner to suffer loss of desire, and arousal or orgasmic dysfunction, so they may both need counselling.
Women with dyspareunia and non consummation take a long time to seek help because of shame or embarrassment. It is important to know that these problems are common, and that you are not alone, and that help is available, and to accept that it is unlikely to get better on its own and that you should ask for help from your doctor or sex therapist.
