Painful sexual intercourse or dyspareunia is a situation where pains persist during sexual intercourse (coitus), after any initial laceration of the hymen has healed. This pain may be witnessed as a result of muscular spasm of the vagina. Though, the superficial ulceration of the tissue may be painful when touched. Painful sexual intercourse may develop later in life as a result of tightness of the vagina area after medical surgery. The tissues or the vaginal walls may have drawn too tightly together. Any form of pelvic inflammation can cause pain during sexual intercourse. But the primary cause of painful sexual intercourse is nervous tension.
The woman may be nursing some fear unconsciously, may be fear of pregnancy, contamination, faulty notion of her female anatomy etc. Also problems like halitosis body odours and lack of understanding from the man may also cause a phobia for sex on the side on the woman.
The root cause can also be traced to a resistance hymen, a narrow introitus or due to some congenital abnormality (though the later is a very rare case). In many cases, difficulty in penetration or painful sexual intercourse may be due to contraction of the perinea muscles (veginismus) due to psychological aversion, and the woman has never allowed penetration to take place.
Treatment of this can be traced to the cause, which is usually a local lesion, though its basis can be psychological oriented (e.g. a changed emotional relationship the fear of pregnancy.
Dyspareunia is categorized into two (2); the superficial pain and the deep pain. The superficial dyspareunia is the pain at the introitus; this may be due to caruncle, acute vulvitis, batholinitis, tender perineal scares, etc. while the second category (deep pain) can be caused by salpingitis, endometriosis or retroversion- in a very rare cases.
Finally, it will be also good to note that psychological cause could be either intrapersonal or interpersonal. Interpersonal in the sense that dyspareunia is the expression of unconscious fear or anger in the relationship, providing an excuse to avoid sex. In this case relationship therapy is recommended. When cervical and vestibular secretion is lacking may be due to inadequate or unskilled sexual stimulation may cause soreness or wound. In this case, the use of lubrication is advisable. A plastic operation is needed or the patient may be given a set of dilators where organic narrowing or obstruction occurs.
In most cases, emotional problems need to be discussed and advice about contraceptive methods may be required.
