Dyspareunia is the clinical name for painful intercourse. 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.

Causes of Dyspareunia Are Multiple

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 person 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:

  • blisters, rashes and inflammation around the vaginal opening or the vulva
  • irritation or infection of the clitoris
  • 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
  • disorders of the urethra or anus
  • 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
  • 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.

Developmental Problems May Contribute to 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 Affects Both Sexes

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 any psychosocial factors.

Copyright 2002 Sinclair Intimacy Institute

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