Dyspareunia is the fact of having pain during sexual intercourse. Often taboo, this symptom is rarely disclosed by women who suffer from it. This discomfort can cause a delay in diagnosis, so it’s important to talk about it with your partner and/or your midwife or doctor so as not to let the problem fester over time. Pain during sexual intercourse can also occur at the beginning of sexual activity. However, they should disappear very quickly. Dyspareunia can be superficial during penetration or deep during intercourse (depending on the position). The pain may also persist after intercourse and be with other symptoms such as discomfort. In the case of intense and regular pain, it shouldn’t be considered normal and can be explained by many pathologies, the first of which is endometriosis.

LUNA helps you

LUNA offers you the LunaEndoScore® test, the CE-certified medical device for the diagnosis of endometriosis, which will allow you to know your own risk of endometriosis by answering a questionnaire based on medical expertise.

Intended use

LunaEndoScore® is intended to assist in the screening of endometriosis by calculating a risk score that determines the probability of being affected by endometriosis based on users’ answers to a questionnaire.

How do I know if I have dypareunia ?

Whether the pain is bearable or makes intercourse impossible, dyspareunia can be completely different for each woman. This pain often appears at first intercourse, but can also occur later. It must be constant over time. Sometimes pain during intercourse can be organic (pathology), temporary depending on the partner, or psychological. So you need to be open enough to talk to your midwife or doctor so that they can determine whether it’s a real, intense and constant pain. Which can also be found during the clinical examination to refer you for further tests. Support from a sexologist is recommended so that the problems don’t become established over time.

What causes dypareunia ?

There are many possible causes of dyspareunia. Without mentioning psychological causes, we will concentrate on physical causes. The first causes may be hormonal: a deficit or reduction in oestrogen (which acts on many tissues in the female body) may be the cause:

Vaginal dryness : which can be identified by pain in the lower abdomen, redness in the external genitalia, itching or even a burning sensation, reduced libido, burning during urination, light bleeding after sexual intercourse or repeated urinary and vaginal infections;

Vaginal atrophy : loss of suppleness and thinning of the vaginal walls, atrophy is due to the reduction of the labia minora which is less irrigated and therefore dry out.

Another cause can be infectious:

Vulvovaginitis: une infection locale de la vulve et du vagin d’origine virale, reconnaissable par une légère enflure des lèvres vaginales avec des démangeaisons. Si elle est liée à la présence de levures, on appelle ça une mycose ;

HSV— Herpes Simplex Virus Infections : reconnaissable par l’apparition récurrente de petites vésicules, douloureuses et remplies de liquide sur la peau, la bouche, les lèvres, les yeux ou encore sur les organes génitaux possiblement aigue par une première infection ou récurrent et chronique.

It can also be due to dermatological causes :

Vulvar lichen sclerosus (VSL) : this is an inflammation of the tissue of autoimmune origin mainly found in postmenopausal women aged 50 to 60 years. It’s recognizable by persistent itching, whitening or paleness of the mucosa which becomes smoother, more fragile and less raised, sometimes even yellowish, and with frequent and painful fissures of the vulva.

Bowen’s disease : this is a form of intraepidermal cancer (superficial layer of the skin). It can be recognized by the appearance of precancerous skin lesions, often in the form of reddish-brown plaques. Often diagnosed in women over 60.

Lichen planus : an itchy rash that forms red or purple patches on different parts of the body. It can be caused by certain medications or a psychoaffective reaction.

Doctors will also look for deep genital infections such as endometritis or their sequelae such as ovarian cysts, cystitis … or Masters and Allen’s syndrome (abnormal mobility of the uterus), Sjögren-Larsson syndrome (SJS, recognizable by scars giving a dry appearance to the skin, but also spasms in the legs) or pelvic congestion syndrome (muscle spasms of the levator ani muscle).

Finally, it is also one of the symptoms of endometriosis:

There are many reasons for endometriosis dyspareunia.

Presence of superficial and deep endometriosis’s lesions consisting, with pain caused by inflammation, a nodule, retraction of the vaginal fundus, or hypersensitivity. In these situations the lesions are seen on vaginal touch and imaging.

Absence of a true endometriosis lesion, a situation found in adenomyosis or postoperative scarring. Generally, these pains are explained by hypersensitivity of the genital region, causing a permanent reflex of the perineal muscles (cramps, myofascial syndrome) and a decrease in the pain threshold of the genital region.

There are therefore many physical causes to explain your feelings of pain during intercourse. It’s therefore important to be careful and to be able to describe your symptoms to a professional so that he or she can give you the best treatment for your dyspareunia.

What treatments are possible?

There are many causes, so treatments may differ depending on your condition. Some causes can be easily treated, but others require more time or sometimes even no treatment at all. There are many treatments that are all too often ignored. Luna offers you some solutions:

For vaginal dryness : this can be treated with a local application of cream or an ovum’s insertion, depending on the number of days required for healing. Using a specific lubricant during sexual intercourse can also help to avoid pain. Vaginal laser treatment is very successful when the dryness is chronic and intractable.

For vaginal atrophy : for postmenopausal women, a new treatment is available to relieve pain with the vaginal laser’s use which will restimulate the vaginal mucosa which lacks estrogen, thus reactivating the lubrication function. For non-menopausal women, this atrophy can be treated by the local application of cream or ovum or by a ring that releases hormones.

For vulvovaginitis : if it’s irritative, you will have to change your habits in terms of sanitary products, whether it’s your period protection or your underwear. If it’s infectious, you will have to take antibiotics or antifungals for a certain period of time, which may vary according to your case. Finally, if it’s atrophic, you will need to take hormonal therapy or products that stimulate lubrication. It can also be a quantitative and qualitative imbalance question of the vagina’s bacteria (vaginal microbiota). A specific assessment by means of a sample accompanied by a treatment to rebalance the bacterial flora gives good results.

For HSV : it can be treated by taking oral antivirals which will prevent the development of the virus enzyme and thus stop it from multiplying. There are many such treatments on the market: Aciclovir, valaciclovir, famciclovir, ovarir, zelitrex or zovirax.

For vulvar lichen sclerosus (VSL) : Unfortunately, there is no cure for this disease. It’s therefore necessary to opt for a lifelong treatment consisting of an ointment or cream application on the vulva skin.

For Bowen’s disease  : there are many treatments, but the most effective cure is surgical removal of the lesions.

For lichen planus : It disappears spontaneously, but its symptoms can be treated even before it disappears with the use of corticoids, repeated exposure to ultraviolet light or even with lidocaine.

For a deep genital infection : there is a treatment to restore the vaginal flora. Depending on the severity of your infection, you will be given antibiotic therapy or bi-antibiotic therapy if it’s more severe.

For Masters and Allen’s syndrome : This involves surgical treatment to shorten or reunite the ligaments.

For Sjögren-Larsson syndrome : Symptomatic treatments for dryness will be avoiding drugs that dry out the body and follow a pilocarpine hydrochloride treatment initially at a low dose with progression over time. It can also be treated locally with certain gels or humidifiers.

For pelvic congestion syndrome : These treatments are for venous insufficiency.

For endometriosis : the treatments are numerous and must be personalized according to the patient. Gradually, hormonal and analgesic treatment will be recommended, surgery if the lesions are constituted and the treatment of painful hypersensitivity always when dyspareunia is installed and depends on the reaction of your system.


Conclusion

Dyspareunia is numerous and can be a symptom of many diseases. You shouldn’t be ashamed to talk about it to determine your disease as clearly as possible. Without all this information, doctors may misdiagnose you and prescribe the wrong treatment or medication.


Read also : How To Live Better With Your Periods

Co-authored and scientifically validated by Dr Jean-Philippe Estrade,

Gynecological surgeon and expert in endometriosis at the Clairval Private Hospital and the Bouchard Clinic in Marseille.