Pain during intercourse
I have a problem with the pain during intercourse
Pain during sexual intercourse, or dyspareunia, occurs with relative frequency in relation to birthing (23%), but even at other stages of life. Dyspareunia often occurs for a period of time, and then disappears by itself. Only 39 % of women never suffer dyspareunia, while one in every six women has it throughout their sexually active life.
Some women experience it only sometimes, while others only in certain positions or just at the start of sexual intercourse. In some cases this can have an affect on the overall relationship with a partner or on life in general.
In many cases, a thorough consultation is recommended, including meeting a sexologist or clinical psychologist. Our goal is to help you and we offer you understanding of your problems. It is important to understand that virtually all cases are complex, and under no circumstances should you ever feel responsible for your problems.
The main problem may be long-term healing, or inadequately healing birth injuries, including painful scarring, loosening of the vaginal walls, pelvic organ prolapse, insufficient lubrication, uterine fibroids, endometriosis, a pelvic inflammation or its resulting effects, a vaginal or bladder infection, lichen sclerosus (an autoimmune disease of the external genitalia), vulvodynia, vaginismus, etc.
How the problem is diagnosed
Diagnosis is based upon a detailed consultation with a sexologist and a urogynecological examination. It is important to identify when and where the dyspareunia occurs. There is a difference between pain at the opening of the vagina (introital dyspareunia) and deeper lying pain.
This is why an examination of both the exterior and interior are necessary. The diagnostic algorhythm is greatly helped if you, yourself, can show the place where the pain is occuring.
A subsequent ultrasound examination can help uncover the cause if located deeper inside the vagina (myoma, endometriosis).
How the problem is treated
The solution depends on the reason for your problems. Often, the approach is interdisciplinary, which is why in our Center for Pelvic-Floor Disorders a urogynecologist, sexologist and psychologist sit side by side. Often the primary problem (painfulscar on the perineum, decrease of vaginal walls or endometriosis) brings secondary psychological problems (fear and distaste for sex life, not enjoying life as such ...).
In the following list, we offer just a selection of the possible treatments on offer:
Application of lubricating agents
This comprises the most simple solution in cases of lower lubrication, which is relatively common in postmenopausal women. This treatment can be simply managed by you, yourself, and does not require our assistance.
Localized application of oestrogen
Application is based upon the effects of oestrogen on the vaginal walls, increasing their elasticity by supporting the production of connective tissues via blood perfusion, and increasing lubrication.
CO2 laser brings about changes at the point of application, particularly to the vaginal tissues, called collagen remodelling, the basic protein building blocks of connective tissue. The heat created leads to vapourization of water from these tissues, and hence to their drying. This leads, in turn, to an increase in the intercellular mass and the activity of the connective tissue cells (fibroblasts), which contribute to the production of new collagen. According to an Italian study, this process leads to an improvement to all aspects of sexuality. Indeed, 85% of women, who were sexually inactive prior to the treatment began their sex life again.
Physiotherapy
Local application of analgesic preparations
If the pain is emitted from a specific place which can be identified, then the direct application of preparations of analgesics, corticoids, or antibiotics to the painful place is possible. In the event of a positive effect, it is possible to repeat this application.
Local application of botulotoxins
In some cases, when the pain emanates from the pelvic floor muscles and can be localized, the application of botulotoxins directly to the painful place, known as trigger points, can be effective for a period of several months. If there is a positive effect, then this procedure can be repeated.
Surgical correction
This is based on the identification of the particular point of dispareunia (unhealed birthing injuries, a scar on the perinium, or a prolapse) followed by surgical repair (developing scarring tissue or reducing the prolapse). It is important to mention that even with sufficient removal of scarring, the same problem can still occur again, because the cause can be related to your specific type of healing process.