Female dyspareunias

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WHEN LOVE IS PAINFUL: Love is synonymous with physical pleasure and relaxation, and yet…

Indeed, love and sexual encounters are supposed to be a source of well-being and not pain. However, statistically for 15 to 20% of women aged from18 to 45 years, painful intercourse is the rule, not the exception.

Dyspareunia: pain felt during penetration or during movements goings of the penis into the vagina is a frequent complaint… If pain occurs at the beginning of penetration, this is called superficial dyspareunia. If pain only appears in a deep penetration, dyspareunia is called deep.

The cycle of pain

This pain has no place in a fulfilling sex life and should not be tolerated. Many women do not care about this symptom in the early stages and gradually leave it invade their sexuality and chew their desire until it is extinguished. Others allow their doctor or their entourage to convince them that everything is “in the head”.They feel guilty because they believe they are the source of their suffering and so, avoid intimate contact… We have to remember that painful experience leads to a fear of its recurrence and generates a anticipating pain stress … Thus, the encounter with the beloved is no longer a source of exchange and loving, but of fear. Moreover, the apprehension of pain leads to a generalized muscle contraction, especially the muscles of the pelvic floor. This contraction causes pain , makes penetrations difficult, leads to weak arousal and poor lubrication :any sensation of pleasure is then impossible. The emotional anxiety generated by this spiral, increases pain. It is worth pointing out that the climate will often find relational disrupted, which increases even more stress. Thus, the woman is trapped in the cycle of pain that psychologically leads to a decline in self-esteem; decreased libido may even lead to depression. Lies or silence do not preserve the couple and the relationship, but amplifies suffering.

Easily identifiable causes

But the causes of dyspareunia are usually easily diagnosable and treatable, in fact, dyspareunia is not a disease in itself but a symptom of a malfunctioning. The latter can be both organic and / or order psycho-relational.

There are mundane reasons such as insufficient preliminary or a lack of desire that prevent proper lubrication and muscle relaxation necessary for an easy and pleasurable penetration.

In addition, the origin of the pain may be organic (gynecological, urinary, vascular,  dermatological, ligament) or psychological. Often several factors interact, because of the loss of self-confidence   and guiltness which take over if the organic factors have lasted. Similarly, the quality of the relationship within marriage is very important: communication, trust and respect are essential to great sex. Finally, the  personnal experience, history, and morals and affects every woman giving a particular  emotionnal color to her sexuality. Thus, in a very strict and culpability centered education, strong social pressure and / or family, but also severe psychological trauma (rape, incest…) can lead to severe dyspareunia.

Different dyspareunia

Pain at the beginning of the penetration

The pelvic exam can diagnose and treat a urinary infection vulvo-vaginale or (cystitis, thrush, a TSI: virus (herpes) or bacterial), dermatitis (eczema, lichen), congenital malformations (abnormal hymen, malformation of the vagina), trauma (following childbirth), an episiotomy badly healed , surgical trauma (surgery for cancer of the uterus), the injury to a sexual trauma (injury penetration, cracks).

Pain in deep penetration

There are mostly gynecological diseases: high genital infection (in the uterus, ovaries and fallopian tubes) or its aftermath, fibroids and voluminousovarian cysts, endometriosis (sterility, significant pain during menstruation), surgical treatment , lesions of the cervix.

“The monologues of the vulva”

Many unknowns remain, and myths around pain and diseases of the vulva both psychological and physical factors interfere and mix. It is however necessary to highlight a few important concepts

Vestibulitis:

It is a superficial dyspareunia located at the entrance to the vagina, in the vestibule (inside the labia minora and vaginal opening) and the range vulvar. Women suffering from vulvodynie feel a burning, feelings of knife wounds or tearing where penetration of the vagina (penis, finger,tampon, and so on.). For some, the pain is also when wearing tight pants or string.

Often misdiagnosed because the vulva looks quite normal (there are sometimes a little redness) vestibulitis, is real and painful. Indeed, the gynecologist with a cotton swab can identify sore spots common to all patients.

The causes of the disease are unknown, but several hypotheses are under study seeking an inflammation or hyperalgesia nerves in the region in question. It is often associated with other chronic diseases such as fibromyalgia, irritable bowel syndrome and interstitial cystitis.

1. Vestibulitis is one of the most frequent reasons for consultation

2. This is neither a sexually transmitted infection nor a cancer or a sign pre –

3. Vestibulitis is not an incurable disease

4. There is no miracle recipe to cure vestibulitis (like those found in the women forums on the web)

5. Vestibulitis is not an “illness in the head.”

A treatment addressing organic, emotional and psychological aspects is the most efficient. So, can be associated guidance for good feminine hygiene and analgesic creams or gels to antidepressant treatment (in the case of mood disorders), or a physical or relaxation even hypnosis. A couple therapy as short or cognitive-behavioral therapy could be of great value.

Persistence of dyspareunia after medical treatment of the cause

Most of dyspareunias have an organic cause at starting point . But what must be understood is that after medical treatment of the dyspareunia cause , there may be a phenomenon of pain conditioning. This conditioning in pain at each intercourse, leads to apprehend penetration, and causes an involuntary contraction of the muscles surrounding the vagina, penetration is then painful , pain that has no more an organic origin, but psychological!

Residual Dyspareunia treatment the will be based on the principle of behavioral therapies, which consist of a gradual desensitization of the fear of pain during penetration, coupled with a training of muscles of the pelvic floor.

This work, step by step, will decondition the woman of her apprehension of pain, and gradually will eliminate pain felt during penetration. The involvement of the partner is recommended.

Sandrine Atallah, MD

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