Painful Sexual Intercourse-Dyspareunia

In our sexual life, as well as desires, desires and pleasure, the feeling of pain, which can vary from person to person and the form of sexual activity, has a place and is natural. The reason is that there is a very close similarity between sexual pleasure and pain. Even in couples who have lost themselves with sexual enthusiasm, the facial expression of a person in pain can be seen at some moments. However, it is common for a “fear of pain” to become ingrained in sexual intercourse because of ignorance or lack of sex education. It is necessary to distinguish this situation from the pain experienced due to a real physical illness. Because over time, instead of enjoying sexual intercourse, it becomes painful. This is because of the fear of pain.

Most sexually active people may experience pain during intercourse at some point in their lives. However, the problem arises if this pain is recurrent and increases with each passing day. This problem can lead to disappointment, sexual reluctance and lack of self-confidence between couples. Many women may experience pain and soreness during or after intercourse (especially during penetration) involving penile-vagina intercourse. This situation is called “dyspareunia”. Women often describe the pain as “pressure and pain in the genital area”, “tearing” or “burning sensation”. Women who experience dyspareunia often experience pain in the vagina, clitoris, inner and outer lips. Some women, on the other hand, may experience a superficial pain at the entrance of the vagina, while they may feel a deeper pain at the further entrance of the penis. Generally, with the fear of this pain, a clinical picture called “secondary vaginismus”, which is characterized by the contraction of the vaginal muscles to prevent the entrance of the penis, may be experienced during intercourse.

Types of dyspareunia

  • Primary Dyspareunia

It is the situation where the complaints of pain during or before and after penetration are present from the first sexual experience.

  • Secondary Dyspareunia

It is the situation where the complaints of a woman who has experienced the sexual intercourse process appear later.

  • Superficial Dyspareunia

There is a pain that occurs at the entrance to the vagina. The reasons are:

  • Structural problems of the hymen; The hardness of the hymen causes a painful and painful intercourse during intercourse.

  • Pain may be felt during union after a difficult delivery process or as a result of infection of the postpartum stitches.

  • During and after menopause, pain and burning sensation may occur due to the irritation caused by the loss of elasticity of the tissues.

  • A painful union can occur as a result of insufficient stimulation resulting from genital infections.

  • A painful and painful intercourse can be experienced as a result of not keeping the foreplay long enough and the vagina not fully wet.

  • Deep Dyspareunia

The pain that occurs in the depths of the vagina and felt in the lower abdomen during the penis-vagina union is called deep dyspareunia. The reason is:

  • Vaginal infections can cause pain.

  • Vaginal mass, tumor, etc. factors can cause pain and bleeding.

  • The union experienced before the woman is ready for union can cause pain and suffering.

  • Pain due to stretching may be experienced as a result of sagging of the vaginal walls.

  • Allergic conditions to synthetic underwear, suppositories, condoms, gels and vaginal washing materials can cause pain.

  • Changes in the vaginal area due to surgery or radiotherapy may cause pain.

  • Abnormalities from birth can cause pain.

Reasons

Dyspareunia may develop due to many factors ranging from a simple anatomical problem to complex psychosocial causes. Therefore, dyspareunia is a specific form of chronic pelvic pain. The reason may be only from the reproductive organ, but also from sources such as digestive system diseases, kidney and urinary tract diseases, musculoskeletal system diseases and mental diseases. Generally, the reasons are as follows:

  • Surgery related to reproductive organs,

  • Genital herpes, vaginitis, pelvic infections etc.

  • Involuntary contractions in women who are concerned about sexual activity,

  • Fear, anxiety, conversion reactions,

  • Incompatibility with the partner,

  • Psychological trauma from the first relationship,

  • Attempting sexual intercourse without foreplay and sufficient vaginal wetness

  • Mass or tumors in the genital organs,

  • Sagging of the anterior or posterior wall of the vagina,

  • Allergic response to foreign bodies in the vagina,

  • Congenital anomalies in the vagina,

  • Endometriosis

  • past pelvic fractures,

  • Lesions related to the urethra or bladder,

  • Digestive system diseases,

  • Diseases of the anus and rectum region such as hemorrhoids, fistula and fissure,

  • Constipation,

  • Inflammatory bowel diseases,

  • Antihistamine etc. side effects of drugs

Ways of Protection

  • Using cotton underwear

  • Wearing comfortable and loose clothing,

  • Wiping the genitals from front to back in toilet cleaning,

  • Preferring a monogamous sexual life,

  • Keeping the genital area away from sweat and moisture,

  • Changing underwear frequently

  • swimming etc. changing wet swimwear immediately after activities,

  • Using vaginal lubricant cream,

  • Don’t use condoms.

Treatment

If dyspareunia is not treated, it also affects the daily life of the woman, harms the relationships she has with the opposite sex, causes vaginismus over time, prevents the pleasure of sexual intercourse, and ultimately damages the self-respect and self-confidence of the woman. The purpose of sexual therapy, which should be done after the diagnosis of dyspareunia made as a result of the gynecological examination; The aim is to eliminate these factors by revealing the psychological or physical causes underlying dyspareunia. Therapeutic efforts in treatment are aimed at 3 important goals:

  • Pain reduction and control

  • Overcoming the negative consequences of pain on life

  • Recreating a satisfying sex life

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