Still little known, dyspareunia causes in women who suffer from its violent pain during penetration. Fortunately, once the diagnosis is correctly established, there are many treatments or therapies that can remedy it.

Dyspareunia is defined as recurrent or persistent genital pain that accompanies any attempt at vaginal penetration (penis, fingers, tampons, etc.) or when moving back and forth in the vagina. Penetration is therefore possible, but (very) unpleasant. The disorder causes personal and couple suffering.

In the event of dyspareunia, the pain can be located in one or more places at the same time, in particular at the entrance of the vagina (vestibule) or inside, at the level of the vulva, the perineum, at the anal level and / or rectal, at the level of the coccyx, near the pubic bone, around the bladder and the urethra, at the level of the clitoris or at the pubic symphysis or in the inguinal region.

Deep or superficial dyspareunia

Dyspareunia is said to be superficial if the pain appears at the start of penetration and is felt in the vulva (vulva, clitoris, vestibule and vagina). It is considered deep when the pain is felt in the back of the vagina, or even in the lower abdomen when the penis touches the back of the vagina. Superficial pain is often described as a burning sensation or irritation, the deep ones are more dull or sharp. Depending on its origin, the disorder may be accompanied by blood loss, abnormal vaginal discharge and strong odours from the genital areas.

Note also that the problem may only occur in certain sexual positions which allow very deep vaginal penetration (especially the doggy style position – vaginal penetration from the rear).

A distinction is also made between primary and secondary dyspareunia. In primary dyspareunia, the pain has always been present, whereas we speak of secondary dyspareunia when the pain occurs after a more or less long period of painless intercourse. Unlike vaginismus, dyspareunia is frequently of the secondary type.

Lack of desire and depression

Dyspareunia can have both physical and psychological consequences. Physically, it often prevents the woman from enjoying. For fear of pain, she will involuntarily, by reflex, contract her vaginal muscles. This apprehension of pain can even suppress any sexual desire, or even reduce the level of arousal and, therefore, vaginal lubrication. Suddenly, the discomfort and pain will be amplified during the sexual act – a real vicious circle!

From a relationship point of view, if the woman with dyspareunia does not dare talk to her partner, she will often try to avoid intimate relations. This will inevitably have repercussions on his life as a couple in the medium term and will also cause personal suffering: shame and guilt, loss of self-esteem or even depression.

When and who to consult?

If the symptoms last for some time, it is strongly recommended to consult a specialist in sexual medicine or sexology, as the causes of dyspareunia are very variable and diverse. It is necessary to consult as quickly as possible in particular when the pain occurs with each sexual relation and prevents the pleasure of the sexual act, if it is felt deep in the vagina and that it does not allow to continue the penetration, if it persists after the sexual act, or if it is accompanied by itching, discharge, odours or, on the contrary, vaginal dryness. It is also recommended to consult quickly if the anticipated fear of pain leads to a decrease in desire, vaginal lubrication and involuntary contractions of the vagina.

80% of dyspareunia have a physiological cause, more or less serious, and this is more the case with deep dyspareunia than superficial disorders. Hence the need to consult without delay. The doctor will be able to determine if the cause is organic or psychological and / or relational. If necessary, he will redirect the patient to a specialist, first of all to a gynaecologist.

Risk factors

There are still many unknowns about dyspareunia. In addition, the risk factors and causes that trigger this disorder are not necessarily the same as those that can maintain it. It is thus possible that after having treated a physical origin such as a yeast infection, dyspareunia persists (psychosomatically). Hence the need, most often, to deal with both the physical problem and its consequences and psychological mechanisms.

The main known causes of superficial dyspareunia are mainly skin conditions, vaginitis (eg, genital infections such as vaginal yeast infection, viral infections such as vaginal herpes, vaginal dryness and atrophy), scarring, enlarged labia minora, etc.

 Deep dyspareunia can also be caused by various factors, such as endometriosis, myomas of the uterus, infections of the cervix, retroversion of the uterus (facing backwards, causing pain during coitus in certain positions only), scars or tears of the perineum, cysts or ovarian infections, viral or bacterial infectious diseases, ovarian tumours, digestive inflammations and infections, abdominal pain, haemorrhoids or the wearing of an IUD (which can cause infections or pain when poorly supported or poorly adapted).

More rarely, deep dyspareunia can be of psychological origin and may develop following depression, anxiety, lack of self-esteem, etc. Conflicts and marital difficulties can also sometimes play a role.

Diagnosis and treatments

Women with dyspareunia often feel ‘abnormal’. While examining them, the doctor should therefore explain to them each of his actions and all his findings to reassure them about their anatomy. The diagnosis is usually made in various stages. In view of the multiplicity of causes and possible physiological factors of dyspareunia, he will carry out medical, gynaecological, dermatological and bacteriological examinations. He should also measure sensitivity to pain in general and check that the patient is not suffering from pain in other areas of her body. He will finally assess the possible psychological and relational factors at the origin of the problem.

The involvement and participation of the partner (already during the first consultations) are very important in the treatment of dyspareunia.

Combined treatments

If the cause of dyspareunia is organic (gynaecological or infectious disease, hormonal disorder, etc.) or psychiatric (especially depression), these problems will first of all be treated appropriately and by the ad hoc specialist (gynaecologist, dermatologist, psychiatrist, etc. .).

Dyspareunia often requires a combination of physical and psychotherapeutic treatments, to be adapted according to the situation and in discussion with the patient. Here are the most recognized for their effectiveness:

  • Lubricating gel: regardless of the treatment undertaken, it is commonly recommended to use a lubricating gel during intercourse. It facilitates penetration and can alleviate the fear of pain. In addition, it generally increases the sensations of pleasure. The doctor can advise the patient on the choice of the most suitable gel.
  • Surgery: Surgery may be necessary and useful in very specific cases (for example, endometriosis, myomas, tumours). If it is used, it is always recommended to combine it with sex/psychotherapy.
  • Local anaesthetic: The application of an anaesthetic ointment containing lidocaine for several weeks every evening helps reduce pain and make intercourse possible in a number of patients.


Sex therapies

Local therapies should generally be accompanied by sex/psychotherapy. Among the most effective, we find pelvic physiotherapy: it is one of the pillars of the treatment of different types of dyspareunia because it allows acting on the pain as well as on the local and general muscular tension by learning to relax the muscles. muscles of the pelvic region. This is done through manual techniques (gentle stretching, massages), muscle contraction and relaxation exercises, and relaxation, breathing and visualization techniques. Vaginal dilators of different sizes are also used to gradually re-educate the vagina for penetration. Although the treatment is centred on the perineum, the relationship of trust that is created between the specialized physiotherapist and the patient also allows a form of psychosomatic care. At the same time, these sessions often introduce women to their own anatomy.

Cognitive and behavioural sex therapy can also be very effective and is scientifically proven. Its objective is gradual desensitization of anxiety linked to penetration and the fear of new pain. This by getting the patient to recognize the thoughts that modulate the intensity of the pain, the feelings that the ailment arouses in her and those that act on the pain, then by learning to act on how to reduce and control the sensations. painful. The therapist will also teach the patient and the couple to restructure their “sexual script”, ie the way the sexual act takes place, to leave more room for erotic activities without penetration.

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