Sexual intercourse, painful
Alternative names:
painful sexual intercourse; dyspareunia
Definition:
Dyspareunia refers to pain in the pelvic area during or
after sexual intercourse. This can occur in men and women.
Considerations:
It is believed that at least 75% to 80% of the time, dyspareunia
is caused by organic (physiological) factors. A common cause
of pain that occurs initially at entry but decreases after
time is inadequate lubrication. This is frequently due to
a lack of sexual arousal and effective stimulation, and sometimes
due to medication that decreases vaginal lubrication (such
as antihistamines).
Psychological factors are infrequently involved and will most
commonly be associated with previous sexual trauma (rape
or abuse), feelings of guilt, or negative attitudes toward
sex.
Women more at risk for dyspareunia include those who are on
medications that produce a general drying effect on body secretions
and those who are postmenopausal (vaginal dryness due to low
estrogen level). Other causes in women include vaginitis
(vaginal infections), endometriosis,
cystitis or urethritis,
orthopedic problems, retroversion
of the uterus, and chronic
constipation.
In men: The most common causes of pain which occurs at the
time of ejaculation are prostatitis and urethritis.
This is often associated with a recent reduction in the frequency
of sexual activity. Pain that occurs while obtaining an erection
may be associated with inflammation of the foreskin, loss
of elasticity of the foreskin, trauma to the penis,
infections (such as herpes) or genital
warts, genital allergies
or irritations, or curvature
of the penis caused by Peyronie's
disease.
Prevention:
Good hygiene and routine medical care will help to some degree.
Adequate foreplay and stimulation will help to ensure proper
lubrication of the vagina.
The use of a water-soluble lubricant like K-Y Jelly may also
help. Vaseline should not be used as a sexual lubricant since
it is not water soluble and may encourage vaginal infections.
Complications:
Eventually dyspareunia inhibits sexual interest as well as
responsiveness. In some cases vaginismus
may occur wherein the vaginal musculature will begin to involuntarily
contract and clamp down as a self-protective way of avoiding
the anticipated pain.
Common causes:
- aggressive or impatient partner
- premature lovemaking following surgery (episiotomy)
or child birth
- menopause, because
of decreased levels of female hormones (vaginal lining loses
its normal moisture and becomes dry)
- hemorrhoids
- genitourinary tract infections (such as a bladder
infection)
- vulvar vestibulitis (inflammation of the vestibule of
the vagina--the area of the perineum that is between the
labia minora including the opening of the vagina
and the urethra) is one of the most common causes of dyspareunia
in women, and is commonly overlooked
- herpes sores (see genital
herpes)
Note: There may be other causes of painful sexual intercourse.
This list is not all inclusive, and the causes are not presented
in order of likelihood. Painful intercourse may be caused
by unlikely diseases and medications. Furthermore, the causes
may vary based on age and gender of the affected person, as
well as on the specific characteristics of the symptom such
as quality, time course, aggravating factors, relieving factors,
and associated complaints.
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
editorial
|
