Rape Can Cause Both Deep and Superficial Dyspareunia
Yes, rape can cause both deep and superficial dyspareunia (painful intercourse) due to physical trauma, psychological factors, and long-term effects on sexual function.
Physical and Psychological Mechanisms
Physical Trauma
- Rape can cause direct physical injury to genital structures that may lead to dyspareunia:
- Tears, lacerations, or abrasions to vulvar tissues
- Damage to vaginal tissues
- Pelvic floor muscle dysfunction or spasm
- Scarring that may develop during healing
Psychological Impact
- Rape trauma syndrome occurs in up to 80% of rape victims 1, contributing to:
- Post-traumatic stress disorder (PTSD)
- Anxiety during sexual encounters
- Fear and anticipation of pain
- Involuntary pelvic floor muscle tension (vaginismus)
Types of Dyspareunia Following Sexual Assault
Superficial Dyspareunia
- Pain at the vaginal entrance during penetration
- Common causes after sexual assault:
- Vulvodynia (chronic vulvar pain)
- Inadequate lubrication due to anxiety or fear
- Vaginismus (involuntary contraction of vaginal muscles)
- Scar tissue at the introitus
Deep Dyspareunia
- Pain with deep penetration
- May result from:
- Pelvic floor muscle dysfunction
- Psychological anticipation of pain
- Tension in deeper pelvic structures
- Possible development of conditions like endometriosis (which has been associated with trauma history)
Long-Term Sexual Effects of Sexual Assault
Sexual assault can lead to various long-term effects on sexual function 1:
- Decreased sexual satisfaction
- Poor use of contraception
- Higher rates of sexually transmitted infections
- Younger age at first voluntary sexual activity
- Greater number of pregnancies and abortions
Assessment Considerations
When evaluating dyspareunia in someone with a history of sexual assault:
- Create a safe and welcoming environment for discussing sexual concerns
- Assess both physical and psychological components
- Consider timing of symptoms in relation to the traumatic event
- Evaluate for comorbid conditions like depression, anxiety, and PTSD
- Screen for suicidal ideation and self-harm behaviors, which are increased in sexual assault survivors 1
Treatment Approaches
Physical Interventions
- Pelvic floor physical therapy to address muscle dysfunction
- Topical analgesics for superficial pain
- Lubricants to reduce friction and discomfort
- Vaginal dilators for gradual desensitization
Psychological Interventions
- Trauma-focused therapy is essential 2:
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Cognitive Processing Therapy specifically for sexual trauma
Integrated Approach
- Combine physical and psychological treatments
- Address both the trauma history and current sexual pain
- Include partners in therapy when appropriate
- Focus on rebuilding healthy sexual experiences at the survivor's pace
Clinical Pearls
- Never assume dyspareunia is purely psychological in sexual assault survivors - always perform appropriate physical examination to identify potential physical causes
- Avoid rushing trauma processing before establishing safety and stabilization
- Remember that dyspareunia can develop years after the assault as a delayed manifestation of trauma
- Recognize that dyspareunia may be just one component of a broader sexual dysfunction picture in assault survivors
Sexual assault survivors with dyspareunia benefit most from a trauma-informed approach that addresses both physical and psychological aspects of their pain, with treatment tailored to their specific presentation and readiness for intervention.