|
Dyspareunia
Dyspareunia
is the clinical name for painful intercourse. This condition can occur at any
age, in both sexes, and the pain can appear at the start of intercourse, midway
through, at the time of orgasm, or after intercourse is completed. The pain can
be felt as burning, sharp, searing or cramping. It can be external, within the
vagina, or deep in the pelvic region or abdomen.
The exact incidence of
dyspareunia is unknown. Masters, Johnson, and Kolodny (Little, Brown & Co.,
1986) found that about 15 percent of adult women have painful intercourse on a
few occasions per year. They estimate that one to two percent of adult women
have painful intercourse more often than that. Spector and Carey (1990) reviewed
the literature on dyspareunia and reported incidence ranging between eight
percent and 23 percent across studies.
The causes of dyspareunia, as
with most sexual dysfunction, can be classified as either organic (physical or
medical factors such as illness, injury or drug effects) or psychosocial
(including psychological, interpersonal, environmental and cultural factors).
The cause of a sexual dysfunction in a given individual may be a combination of
several factors, and in some cases, the precise cause may not be identifiable at
all.
Female dyspareunia can be caused
by dozens of physical conditions. Any condition that results in poor vaginal
lubrication can cause discomfort during intercourse. Among the more common
culprits are drugs that have a drying effect (antihistamines, certain
tranquilizers, marijuana) and disorders such as diabetes, vaginal infections,
and estrogen deficiencies. Other causes of female dyspareunia include 1)
blisters, rashes and inflammation around the vaginal opening or the vulva; 2)
irritation or infection of the clitoris; 3) disorders of the vaginal opening,
such as scarring from an episiotomy, intact hymen
or remnants of the hymen that are stretched during intercourse, or infection of
the Bartholin's
glands; 4) disorders of the urethra or anus; 5) disorders of the vagina,
such as surgical scarring, thinning of vaginal walls (whether due to aging or
estrogen deficiency), and irritation due to chemicals that are found in
contraceptive materials or douches; and 6) pelvic disorders such as infection,
tumors, abnormalities of the cervix or uterus, and torn ligaments around the uterus
.
Psychosocial causes of
dyspareunia may be as frequent and varied as organic ones. It is usually much
more difficult to develop a clear understanding of how psychosocial factors
contribute to sexual dysfunction, including dyspareunia. Many authorities
believe that developmental factors such as troubled parent-child relationships,
negative family attitudes toward sex, traumatic childhood or adolescent sexual
experiences, and gender identity conflicts may all predispose one toward
developing a sexual dysfunction. In cases of dyspareunia, if a child has been
brought up to believe that sex is wrong and will cause pain, that person as an
adult may well feel pain with intercourse. Similarly, a painful previous sexual
experience can create an expectation of painful intercourse in future
experiences. Personal factors such as anxiety, fears of pregnancy, intimacy and
rejection, to name a few, may block the pathways of sexual response and lead to
pain. Relationship problems or interpersonal conflicts such as power struggles,
hostility toward a partner, preference for another partner, distrust, poor
communication and lack of attraction to a partner can all emerge as pain during
intercourse.
Other feelings and psychological
conflicts may also affect sexual responsiveness, inhibiting or reducing vaginal
lubrication, which can result in painful intercourse. Guilt, depression and poor
self-esteem are commonly encountered in association with sexual dysfunctions.
However, it is not always clear which came first, the feelings or the
dysfunction. Because it is not unusual for people who have sexual problems to
become depressed about them or to experience lowered self-esteem, identifying a
problematic feeling does not always mean it caused the dysfunction.
Dyspareunia is generally thought
of as a female sexual dysfunction but it also affects males. Typically, the pain
is felt in the penis but it can also be felt in the testes or internally, where
it is often associated with a problem of the prostate or seminal vesicles.
Organic causes of dyspareunia in
males include inflammation or infection of the penis,
the foreskin, the testes, the urethra, or the prostate
gland. Less common is pain resulting when the tip of the penis is scratched
by the tail of an IUD
(intrauterine device, a form of female contraception). Men sometimes develop
painful penile irritation when exposed to some vaginal contraceptive foams or
creams. It is about equally as likely for the cause of male dyspareunia to be
psychosocial in nature. Nearly all of the psychosocial issues that may
contribute to female dyspareunia apply to men as well.
Dyspareunia can usually be
treated once the probable causes have been identified. Organic diseases can
typically be addressed after a thorough gynecological or medical examination,
and psychotherapy can usually help with the psychosocial factors.
|
Sex
