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What is dyspareunia?

Dyspareunia is pain while having sex. The definition includes pain before, during and after sex not specifically due to a dry vagina or vaginismus. This is quite common among women, but men also get dyspareunia. It is a treatable condition even if a person has had it for a long time.

What causes dyspareunia?

The two most common general causes of dyspareunia are vaginismus and a retroverted uterus. Vaginismus is an involuntary spasm of the vagina's musclar wall, making any type of vaginal penetration very painful. This spasm is similar to the way in which the eyelid suddenly shuts down when an object comes near it. The woman has no control over the spastic movements. Vaginal lubricant gel, progressive vaginal dilatation, and psychotherapy help with vaginismus.

A retroverted uterus is the situation where the uterus bends back instead of forwards. The uterus normally makes a 90 degree angle with the vagina and bends forwards. Retroversion means the uterus makes an angle with the vagina while bending backwards. Shifting of the uterine position during sex stretches the ligaments causing pain.

An ultrasound scan will show gross uterine anatomy and the uterus' position in the pelvis. No surgical intervention is necessary. Pain killers relieve symptoms. There is no evidence that retroversion of the uterus affects fertility.

Infections are a common cause of dyspareunia. Skin commensals and enterobacteria can enter the lower genital tract easily in females because of the anatomical position of the vagina, urethra, and anus. Chlamydia, candidiasis, and Trichomonas are a few common culprits. Pelvic infections present with lower abdominal pain, fever, dyspareunia, backache and dysuria. An ultrasound scan will show a thin layer of free fluid in the pelvis. High vaginal swab for culture, Pap smear, a full urine report and culture are routine investigations. Pain killers, antibiotics, and antifungal agents are the mainstay of treatment.

Large tumours may stretch pelvic ligaments causing pain. Fibroids and ovarian cysts are very common. An ultrasound scan can measure the fibroid/cyst size. Myomectomy is a procedure where only the fibroid is taken out. Some may go for hysterectomy. Fibroids may undergo degeneration. They do not transform into cancers.

Vaginal dryness leads to superficial dyspareunia. Scarring after vaginal delivery and a tight episiotomy suturing leads to a tight vagina and in turn to superficial dyspareunia.

Endometriosis is the presence of endometrial tissue in sites other than the normal uterine cavity. These ectopic tissues are also hormone responsive. The broad ligament, ovarian surface, the pouch of Douglas and the bladder surface are a few common ectopic sites. Bleeding into the peritoneum irritates it, causing intense pain. This pain precedes and outlasts menstrual bleeding. Inflammation of pelvic tissues results in pain during sex.

Gynecologists attempt to control symptoms with medical management before moving on to surgical procedures. Mild to moderate endometriosis in young women tends to improve once they get pregnant.

Transvaginal septa and a thicken hymen may cause pain during early penetration.

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