By Dr. Courtney Cheng, D.O., M.S.H.S.
What is dyspareunia? Pain with intercourse (dyspareunia) is a common concern among young childbearing-aged women. About 15-20% of US women in reproductive age complain about having pain during vaginal penetration. The cause of this pain can be anatomical, neurological, or psychological in nature. A health care professional can help to differentiate the cause of this problem and provide management for resolution of the pain. If not properly managed by a physician, the pain can worsen, resulting in a negative attitude to sexual intimacy, more problems with sexual function, decreased happiness and relationship discord.
Understanding the anatomy and physiology can help guide common treatable causes of pain with intercourse. By understanding the cause, a holistic approach can be applied that address the cause and rather than suppressing the symptoms. The natural, non-drug therapies described do not replace the role of a qualified medical professional. If you try one of the recommendations with worsening of your condition, you should cease immediately and consult a health care professional.
CONNECT WITH YOUR BODY
What causes dyspareunia? Dyspareunia can be classified by the location of the pain as insertional, pain with vaginal entry, or deep, which is associated with deep
thrusting. Many women may experience both insertional and deep dyspareunia.
Insertional dyspareunia is associated with problems with the outer layers of the vaginal wall. In contrast, deep dyspareunia is more associated with problems of the uterus inside.
Dyspareunia can also be classified by the onset of the pain. Young child-bearing female with pain is commonly associated with poor lubrication and a negative attitude toward sexuality. Postpartum dyspareunia is more commonly associated with vaginal trauma during the course of spontaneous vaginal deliveries. However, women with cesarean deliveries are also reporting pelvic pain.
HARMONIZE WITH YOUR SEXUALITY
How can dyspareunia be treated? Treatment modalities for
dyspareunia are dependent on the underlying cause. If you are having pain upon vaginal entry, try using external lubrication, with concurrent psychological counseling. Try new positions and determine whether the pain is only with certain positions. Communicate with your partner what is pleasurable to each other. Deep dyspareunia may have surgical indications, and may include ablation
of endometriosis, lysis of adhesions, or restoration of the normal anatomy.
INTEGRATE OSTEOPATHY
Recently, I have been seeing many patients with dyspareunia. Each case was due to a different cause and thus had to be dealt with differently. In the first case, the patient had endometriosis causing her pain with deep penetration. Instead of being surgically treated, she had regular osteopathic treatments to alleviate the pain until she unexpectedly became pregnant. The pregnancy and natural change in her cycle resulted in improvement of her symptoms.
She referred a friend who had pain with intercourse following the birth of her first child via Cesarean section. During her osteopathic treatment, myofascial unwind of the fascia revealed the emotional trauma that she underwent during the surgery in which she described being forcibly lifted off the surgical table as her child was pried out of her. Her husband witness to the trauma has been cautious and anxious about further hurting her. Removing the trauma and the fear that went with it allowed this couple to resume intimacy in a renewed way.
In another case, dyspareunia began after an individual had her uterus removed prophylactically after she was diagnosed with breast cancer. The early penetration pain was not their prior to the surgery and she is in a happy monogamous relationship with her husband who has been supportive throughout. In this situation, despite proper lubrication, the thin friable nature of the vaginal tissue caused her pain and corresponded with her history of hysterectomy. In this situation, she was referred to a gynecology oncologist who specializes in these special circumstances since hormone replacement may increase her chances of developing further cancers.
If you are unable to find relief from the holistic and natural approach, you can discuss with your health care provider options of biofeedback, physical therapy and medical management. Antidepressants and hormone replacement therapy have both been found to be effective when used appropriately.
Recently, I have been seeing many patients with dyspareunia. Each case was due to a different cause and thus had to be dealt with differently. In the first case, the patient had endometriosis causing her pain with deep penetration. Instead of being surgically treated, she had regular osteopathic treatments to alleviate the pain until she unexpectedly became pregnant. The pregnancy and natural change in her cycle resulted in improvement of her symptoms.
She referred a friend who had pain with intercourse following the birth of her first child via Cesarean section. During her osteopathic treatment, myofascial unwind of the fascia revealed the emotional trauma that she underwent during the surgery in which she described being forcibly lifted off the surgical table as her child was pried out of her. Her husband witness to the trauma has been cautious and anxious about further hurting her. Removing the trauma and the fear that went with it allowed this couple to resume intimacy in a renewed way.
In another case, dyspareunia began after an individual had her uterus removed prophylactically after she was diagnosed with breast cancer. The early penetration pain was not their prior to the surgery and she is in a happy monogamous relationship with her husband who has been supportive throughout. In this situation, despite proper lubrication, the thin friable nature of the vaginal tissue caused her pain and corresponded with her history of hysterectomy. In this situation, she was referred to a gynecology oncologist who specializes in these special circumstances since hormone replacement may increase her chances of developing further cancers.
If you are unable to find relief from the holistic and natural approach, you can discuss with your health care provider options of biofeedback, physical therapy and medical management. Antidepressants and hormone replacement therapy have both been found to be effective when used appropriately.