What happens when sex is painful?

Dyspareunia (painful sex) is a very common problem amongst women of different ages. Despite the high prevalence of this condition, women often feel shy, fearful and uncomfortable discussing about that. This very personal “problem” can cause anxiety and stress but women should be aware that in most of the cases there are effective treatments.Dyspareunia sometimes evolves into a more complicated problem affecting not only womens’ personal lives but also their professional and social ones. All of these can have a negative impact in their mentality, their confidence and generally their well-being.

Dyspareunia can be caused by many factors both medical or psychological.

Women experiencing painful sex should seek advice from a specialist who will not only be able to relieve symptoms but also to fully cure them.

What kind of pain is there in dyspareunia?

Investigation of the type of pain that appears during sex can also reveal its possible cause. It is very important to elicit information such as if the pain is superficial or deeper located.

Each  kind of pain has its own cause and its own unique treatment.

Deep dyspareunia

 This kind of pain can appear shortly after the initial  penetration, can deteriorate during sex and can last for several hours after the intercourse. Women experience this kind of pain as a deep pain into the pelvis (lower abdomen).

The most frequent causes of the following:

  • Endometriosis: Endometriosis is the condition where tissue similar to the endometrium (which lies inside the uterus) can be found in other areas outside the uterus. When endometriosis grows behind the vagina or behind the lower part of the uterus (uterosacral ligaments) sex can be painful and pain can last many hours after intercourse.
  • Pelvic Inflammatory Disease (PID): Pelvic inflammation is another cause of deep dyspareunia. The most common aetiology is sexually transmitted diseases, such as chlamydia, and patients must receive treatment on time in order to reduce the risk of damage the fallopian tubes.
  • Myomas: Myomas are benign masses which originate from the muscle of the uterus. They can cause heavy menstrual bleeding and pain during sex.
  • Adhesions: Adhesions are fibrous bands that form between tissues and organs often as a result of a previous surgery or infection. These adhesions cause stretching and pulling of different organs in the pelvis and this can cause intense pain. Adhesions are usually found in endometriosis patients.
  • Prolapse: Prolapse of the uterus inside the vagina can cause pain during sex and also discomfort in general.

What kind of investigations should i have?

Personal medical history: Obtaining a detailed medical history is the necessary first step to completely understand the type of pain and its possible causes.

Clinical examination: This will reveal areas of increased sensitivity and pain. The endometriosis surgeon will be also able  to identify nodules of endometriosis as well as an increase in the size of the uterus.

Other exams: Most of the times having an ultrasound or an MRI can add further valuable information.

Diagnostic laparoscopy is a powerful “tool” which offers the most accurate evaluation in the hands of an experienced Gynaecology Endometriosis surgeon.

Treatment of dyspareunia is extremely important. If dyspareunia is left untreated the patient may get overwhelmed by fear and stress. Her quality of life can be affected in such a degree that it may become devastating.

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