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We can classify dyspareunia as superficial or deep, depending on the pain it produces. The superficial is the one that occurs at the entrance to the vagina with penetration or even with the placement of a tampon. Deep dyspareunia occurs on deep penetration and is a pain more referred to the bottom of the vagina or in the lower half of the abdomen.
Causes of dyspareunia
There are many causes of pain with relationships, which can be different in superficial or deep dyspareunia and can also appear simultaneously in the same woman.
Superficial dyspareunia can be caused by:
- Infections: they can be both bacterial and fungal or viral. The infection of the discharge produces an inflammatory reaction that usually causes painful intercourse. Even in patients with urinary tract infections without a vaginal infection, dyspareunia can occur.
- Insufficient lubrication: this may be due to a short preparation before penetration that has not given time to the necessary lubrication. Other causes can be the drop in estrogen that occurs in menopause or after childbirth or during breastfeeding. Diseases that occur with drier mucous membranes can also cause dyspareunia as well as being a side effect of some medications.
- Postpartum scars: Sometimes the scars from possible tears or postpartum episiotomies can be painful to the touch and penetration.
- Injury to the genital area due to an accident, trauma or genital mutilation.
- Skin diseases such as some eczema, or lichen sclerosus.
- Allergies to condoms, both latex and the lubricants they carry.
- : are the involuntary contractions of the wall of the vagina that closes the vaginal entrance and narrows the caliber of the vagina.
Profound dyspareunia can be due to:
- Uterine fibroids: certain fibroids can cause pain with intercourse depending on their position and size.
- An infection of the internal genitalia produces a very important inflammatory reaction that, despite proper treatment, can cause dyspareunia for a long time.
- Endometriotic nodules in the abdomen, infiltration of the wall between the vagina and rectum of endometriotic cells and the adhesions between tissues that this disease produces often lead to sexual intercourse that can be very painful at times.
- Ovarian cysts: it is less frequent but on some occasions some ovarian cysts cause pain with intercourse due to a matter of physical space or they can cause the cyst to rupture and blood in the abdomen.
Diagnosis
Treatment
The treatment of dyspareunia is very different depending on the cause that causes it. If it is an infection, the necessary antibiotic or antifungal treatment should be administered. In some cases, after treatment, vaginal discharge is still less and it takes time to regain normal discharge and lubrication. In cases where there is a lack of lubrication, specific lubricants can be used for sexual intercourse that reduce pain. Massages with rosehip oil can help reduce pain caused by scars from childbirth or trauma, giving more elasticity to scar tissue that is not very elastic. When there are alterations of the internal genitalia such as fibroids, cysts, malformations, endometriosis ... the doctor should assess the surgical options in each case.
- Physical examination: An examination of the first should be done. Rule out skin lesions, infections, trauma ... then the vagina and cervix should be explored to rule out malformations, infections, nodules, and assess muscle tone. Finally, a vaginal examination should be performed to assess the pelvis.
- Complementary tests: It may be necessary to request a flow culture to rule out infections, perform an ultrasound of the internal genitalia to assess their normality and rule out fibroids, cysts ... and it may be necessary to perform other tests such as a pelvic magnetic resonance or an MRI to evaluate other devices or to rule out endometriotic lesions that are not clear on ultrasound.
(Updated at Apr 14 / 2024)