From the Guidelines
Dyspareunia, or painful sexual intercourse, is primarily caused by a combination of physical and psychological factors, including vaginal dryness, pelvic floor dysfunction, and hormonal changes, as well as anxiety, depression, and past sexual trauma. The etiology of dyspareunia can be complex and multifaceted, involving various physical and psychological components. Physical causes include vaginal infections, skin conditions, hormonal changes leading to vaginal dryness, pelvic inflammatory disease, endometriosis, vaginismus, and structural abnormalities [ 1 ]. Psychological factors contributing to dyspareunia include anxiety, depression, stress, past sexual trauma, and relationship problems [ 1 ]. Medical conditions such as interstitial cystitis, irritable bowel syndrome, or pelvic floor dysfunction can also cause pain during intercourse [ 1 ].
Key Factors Contributing to Dyspareunia
- Vaginal dryness, often caused by hormonal changes during menopause or breastfeeding [ 1 ]
- Pelvic floor dysfunction, which can be treated with pelvic physical therapy [ 1 ]
- Anxiety, depression, and past sexual trauma, which may require psychotherapy [ 1 ]
- Medical conditions such as interstitial cystitis, irritable bowel syndrome, or pelvic floor dysfunction [ 1 ]
Treatment Options
- Topical estrogen for vaginal dryness [ 1 ]
- Antibiotics for infections [ 1 ]
- Physical therapy for pelvic floor dysfunction [ 1 ]
- Lubricants and moisturizers to alleviate symptoms such as vaginal dryness and sexual pain [ 1 ]
- Psychotherapy for psychological causes [ 1 ]
- Surgery for structural issues [ 1 ]
A comprehensive evaluation by a healthcare provider is essential to determine the specific etiology and develop an appropriate treatment plan, taking into account the individual's medical history, symptoms, and quality of life [ 1 ].
From the Research
Etiology of Dyspareunia
The etiology of dyspareunia, or painful sexual intercourse, is complex and multifactorial. Some of the common causes of dyspareunia include:
- Vulvodynia, a condition characterized by chronic pain in the vulvar region 2, 3
- Inadequate vaginal lubrication or arousal 2, 4
- Endometriosis, a condition in which tissue similar to the lining of the uterus grows outside the uterus 2, 5, 6
- Postpartum dyspareunia, which can occur after childbirth 2, 4
- Pelvic floor dysfunction, which can cause pain during sexual intercourse 2, 3
- Vaginismus, a condition characterized by involuntary contraction of the pelvic floor muscles during attempted penetration 3
- Uterine retroversion and pelvic masses, which can cause deep dyspareunia 2
- Interstitial cystitis, a condition characterized by chronic pain in the bladder and pelvic region 5
- Pelvic congestion syndrome, a condition characterized by chronic pain in the pelvic region due to varicose veins 5
Classification of Dyspareunia
Dyspareunia can be classified based on the location of the pain, with superficial dyspareunia referring to pain during attempted vaginal insertion and deep dyspareunia referring to pain during deep penetration 2, 6. It can also be classified based on when the pain was first experienced, with primary dyspareunia referring to pain that has always been present and secondary dyspareunia referring to pain that develops after a period of pain-free sexual activity 4.
Pathophysiology of Deep Dyspareunia
Deep dyspareunia can be caused by a variety of factors, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders 6. The pathophysiology of deep dyspareunia can be classified into four categories: type I (primarily gynecologic), type II (nongynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed) 6.
Diagnosis and Treatment
Diagnosis of dyspareunia typically involves a detailed history and physical examination, including a visual inspection of the external genitalia and a sequential pressure with a cotton swab to assess for focal erythema or pain 2. Treatment of dyspareunia is focused on the underlying cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections 2, 3.