Dyspareunia is essentially a “basket” diagnosis as it does not describe specifically what is wrong. If the physician wants to note that you have pain but as yet has not determined what is causing the pain, she may diagnose you with dyspareunia. The first step in treating dyspareunia is isolating the problem, which can sometimes take a few visits and some trial and error. Finding a practitioner with broad expertise and the patience to really listen to you is key in identifying the cause(s) and eventually treating the underlying problem.
Symptoms of dyspareunia can include: pain upon penetration, sudden pain after intercourse, deep pain during thrusting, and burning pain anywhere in the pelvis.
Dyspareunia is diagnosed through a careful history and physical exam. Once a physician has diagnosed dyspareunia, they will get started trying to identify the underlying cause. Doing so may involve further exams, working with dilators, imaging (ultrasounds or MRIs), biopsies or other tests. Sometimes treatment may be started on a trial basis. If the treatment works it may give the physician more information about the underlying cause.
Pain during sex is often associated with a wide range of physical and/or emotional factors.
- Inadequate lubrication
- Injury or trauma
- Vulvar Dermatoses
- Reactions to birth control products
- Tight muscles
- Anatomical issues
Sometimes dyspareunia can be caused by other underlying medical problems: i.e. endometriosis, uterine fibroids, and ovarian cysts
Emotional issues can be a factor as well. Often when women have experienced pain in the past, they can unintentionally tighten muscles, which just contribute to the pain/fear cycle. If there is tension in the relationship and a woman does not want to be having sex she might not lubricate or she might tighten her vagina. This can be the case as well if a woman has suffered sexual abuse. However, there are many women who have experienced sexual abuse who go on to have full and satisfying sex lives and there are many women who have sexual problems who do not have a history of sexual abuse. Therefor it is a serious mistake to assume that anyone with sexual problems must have been sexually abused.
Dyspareunia is the most general diagnosis for pain with sex. All other pain syndromes fall under the diagnosis of dyspareunia so it is misleading to suggest that they are “confused” with each other. More commonly, dyspareunia is the first diagnosis and the physician then determines a more specific diagnosis.