Female dyspareunias

When Love is Painful

Love is often associated with physical pleasure and relaxation. However, this is not the case for every individual, as painful experiences during sexual intercourse persist for many, disrupting what should be a source of joy and connection.

Statistically, 15 to 20% of women aged 18 to 45 years find painful intercourse to be a regular occurrence, rather than an exception. This phenomenon is often categorized under the term dyspareunia, which refers to the pain felt during penetration or the movements during intercourse. The pain can be superficial, occurring at the onset of penetration, or deep, felt more intensely during deeper penetration.

The Cycle of Pain

It is important to emphasize that pain has no place in a fulfilling sex life and should not be endured. Many women neglect this issue in the early stages, allowing it to gradually infiltrate their sexuality and diminish their desire over time.

Fear of recurring pain can generate stress, transforming intimate encounters from a loving exchange into a source of anxiety. The anticipation of pain can trigger generalized muscle contraction, including in the pelvic floor muscles, leading to difficult penetration, decreased arousal, and inadequate lubrication, thereby eradicating any potential pleasure.

In this vicious cycle, the affected individual might experience a decline in self-esteem and libido, possibly spiraling into depression. Silence and dishonesty do not protect the relationship; instead, they amplify the suffering.

Identifiable Causes

Fortunately, dyspareunia is typically diagnosable and treatable, being more a symptom of an underlying issue than a disease in itself. The origins of this dysfunction can be both organic and psychorelational.

Common reasons include inadequate foreplay, leading to insufficient lubrication and muscle relaxation. The issue can also stem from organic issues including gynecological, urinary, vascular, dermatological, and ligament problems, or psychological factors. Often, a complex interplay of several factors is at play.

Moreover, the personal experiences, history, and moral background of an individual can significantly influence their sexual experiences, lending a unique emotional color to their sexuality.

Types of Dyspareunia

Superficial Dyspareunia

A pelvic exam can diagnose and treat problems like urinary or vulvovaginal infections, dermatitis, congenital malformations, or traumas resulting from childbirth or surgery.

Deep Dyspareunia

This is often linked to gynecological issues such as high genital infections, fibroids, voluminous ovarian cysts, endometriosis, or cervical lesions.

“The Monologues of the Vulva”

Despite advancements, many aspects of vulva pain and diseases remain shrouded in myths and misunderstandings, with psychological and physical factors intertwining. It is essential to highlight some vital concepts here.

Vestibulitis

A subset of dyspareunia, vestibulitis is localized at the vagina’s entrance, characterized by a burning sensation or feelings akin to knife wounds. Despite the intensity of the pain, the vulva might appear normal, albeit with occasional redness. Vestibulitis is a real and often underdiagnosed issue, not an “illness in the head.”

Treatment and Recovery

A comprehensive treatment addressing the organic, emotional, and psychological aspects often proves to be the most effective. This approach might include guiding individuals in maintaining proper feminine hygiene, prescribing analgesic creams or gels, psychotherapy, pelvic floor physiotherapy and possibly recommending antidepressant treatments in cases of mood disorders.

Residual Dyspareunia

After the primary cause has been medically addressed, some individuals experience a kind of conditioned response where the anticipation of pain leads to involuntary muscle contractions, making penetration painful. This form of dyspareunia is psychological, and treatment involves behavioral therapies aimed at gradual desensitization and pelvic floor muscle training. It’s a step-by-step process to eliminate the fear and the resultant pain, and involving the partner in this process is recommended.

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