Dyspareunia: Don’t Choose Between Pleasure and Pain

Intercourse is always associated with pleasure the expression, connection, and satisfaction. While many people can experience this pleasure, there are some who are unfortunately plagued by pain. Sometimes, sex hurts. But one shouldn’t assume that it is normal, DR EMANUEL GRACIAS addresses the case

The idea that it is okay for sex to be painfully unpleasant sometimes, should at once be dropped – it’s not okay. Besides the physical, emotional, and spiritual aspects, the ability to have sex can be hindered by other reasons not external to the body. One of these reasons is simply pain- pain before, during, or after intercourse. When such a feeling of throbbing discomfort arises persistently or recurrently, it is known as dyspareunia.

Some people claim that it hurt during the first time they engaged in sex. However, it isn’t the case for all and shouldn’t be seen as an expected parcel of sexual encounters. Pain at any stage of your sexual journey, be it the first time or well after it, is a matter of concern. There are several reasons why one may experience painful intercourse. There are both physical and psychological causes.

Physical causes of such pain include sexually transmitted diseases (STDs), fungal infections, pelvic inflammatory disease (PID), cervical fibroids, and deep seated endometriosis. Skin to skin contact during intercourse can be extremely uncomfortable and painful, triggering inflammation and irritation. Menopause too, is a prevalent physical cause, stemming from decreased oestrogen levels and less elastic vaginal tissues that make sex not just painful, but also almost impossible. Another physical reason could be vaginal dryness. Inadequate lubrication leads to friction and pain during intercourse.

Among the various psychological causes of dyspareunia, vaginismus attains primary significance. Described as an involuntary tensing of muscles around the vagina, vaginismus is fraught with recurrent or persistent difficulties in vaginal entry of any sort. The ambiguous or identified fear of penetration could be one of the indicators of vaginismus, besides trauma from sexual abuse or violence, uncomfortable first time sexual encounters, and in some cases, even strict religious and cultural beliefs that shape the idea of sex. Pain before intercourse primarily arises due to the anticipation that it will hurt. Many women continue to endure the excruciating pain of intercourse, primarily due to the fear of being labelled as ‘defective’, ‘faulty’, or even ‘abnormal’. They are consumed by the feeling of inadequacy on not being able to express themselves sexually. Acknowledging the fact that sex hurts, should be the first thing on your list in such a case. Do not continue to bear the pain silently. Communicate with your partner. Talk about the issue. The condition can also be self-managed through different coital positions, adequate lubrication, and generous foreplay. Consult a therapist or seek counselling services to locate the fear, if any, and to resolve it smoothly.

The next step would be to visit your gynaecologist. Open up to your doctor about your pain. Do not get embarrassed while explaining the case. A thorough history of the case is needed to determine whether the pain has been present for a considerable period or is a relatively new phenomenon, whether it occurs with every sexual partner or just one specific partner.

A pelvic exam will be undertaken to check for signs of inflammation or irritation to determine if the pain is caused by any sort of infection or even endometriosis. To detect possible cervical cysts and fibroids, a trans-vaginal ultrasound is conducted.

Treat the cause: This is the mantra for all actionable outcomes of the diagnosis and treatment of dyspareunia. If the pain is psychological, potentially indicating vaginismus, treatment options would typically comprise of modalities used to deal with vaginismus. Cognitive Behavioural Therapy (CBT) is used to help patients understand how their thoughts and emotions coincide with their behaviours and reactions. If vaginismus is primarily incited by fear of physical damage to the insides, an effective treatment option is practicing kegels or pelvic floor exercises.

This also applies to the treatment of physical causes of painful intercourse. Cases of STDs, fungal infections, and PIDs are managed through the typical treatment options available for these ailments. Similarly, if it is menopause that’s causing the discomfort during sex, you may be prescribed low-dose oestrogen to deal with the vaginal dryness. Use a lubricant before and after sex to relax the tightness and minimise the chafing. Cervical cysts, fibroids, and endometriosis too, are dealt with according to the prescribed modality of treatment. While treating all these causes can be treated to their core individually, the rules of care and caution often coincide. As the treatment takes its course, remember that you are as worthy and deserving of a sexually fulfilling life as anyone else. Enduring the pain, thinking that it will somehow ‘numb’ the hurt only contributes to making dyspareunia a highly under diagnosed condition. Remember, sex should never hurt. If it does, something is wrong and that something needs to be addressed. You shouldn’t have to choose between pleasure and pain.

The writer is an Obstetrician and Gynaecologist at Gracias Maternity Hospital in Margao. Email: emanuelgraciasmd@gmail.com




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