Dyspareunia - pain during sex

In this guide, I would like to sort out the terms "vaginismus" and "dyspareunia" a little. Numerous inquiries from our customers and my clients as a therapist have made it clear that information regarding the distinction between vaginismus and dyspareunia would be helpful. Both complaints cause eminent pain during sex with penetration or make sexual intercourse impossible, but are quite different.

The official medical diagnoses for dyspareunia, vaginismus or other forms of pain during sex are very complex. But because they also differ from one another in some cases, they are difficult for laypeople to understand, especially since the therapists who treat them describe the transition from one "illness" to the other as fluid. Both complaints are classified as so-called sexual dysfunctions that cause pain during sex. It seems sensible to me, as a therapist, to address affected women and possibly their partners directly in my description.

Contents:

What is dyspareunia

The term “dyspareunia” encompasses various complaints in the female genital area.

The official definition according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems) of the WHO (World Health Organization) distinguishes two forms:

• Organic dyspareunia (code N94.1)
• Nonorganic (psychogenic) dyspareunia (code F52.6)

Both forms of dyspareunia are considered chronic.

A further explanation is provided by the DSM IV, the manual of the American Psychiatric Society. It describes dyspareunia as “recurrent genital pain associated with penetration (> 6 months)not associated with lack of lubrication or medical conditions.”

This means that the woman has been experiencing pain during sex (intercourse) for more than half a year, and this is not due to a lack of or insufficient lubrication. What is confusing is the passage that it has nothing to do with a medical condition either. Because that is exactly the case with the organic form.

A) Organic dyspareunia

Organic refers to physical, i.e. actually visible, physically existing causes of complaints.

Here, too, there are two variants:

• Deep organic dyspareunia

The best known and most common forms are the following:

• • atrophy (thinning of the tissue of the vagina and possibly the vulva)
  • Inflammation of the vagina, bladder or urethra
  • Endometriosis (pathological growth of the uterine lining outside the uterine cavity in the abdominal cavity)
  • Retroflexed uterus (uterus bent backwards)
  • tumors, cysts
  • scar tissue
  • Hemorrhoids
  • irritable bowel syndrome
  • High tone pelvic floor dysfunction (hypertonia = very high tension in the pelvic floor muscles)

• Superficial organic dyspareunia

Here are the most popular ones:

• • Inflammation of the vulva, vagina, urethra or Bartholin's glands
  • atrophy (see above)
  • Vulvodynia = dyspareunia of the vulva, the causes can be varied
  • Vestibulitis vulvae syndrome = see vulvodynia, only more in the vaginal entrance
  • Hymen anomaly (unusual structure of the hymen, the existence of which is very controversial)
  • Skin diseases such as lichen, psoriasis,
  • scarring
  • radiation
  • penis oversize

It is easy to imagine that all these problems can hinder or even prevent sexual intercourse, and in any case make it painful.
Logically, the treatment is initially aimed at alleviating the physical symptoms and, in the best case, curing them. However, even in the organic form of dyspareunia, possible accompanying psychological causes should be taken into consideration.

B) Nonorganic dyspareunia

This term initially covers all those affected who, without any visible cause,Having pain during sex, more precisely: during penetration, i.e. during classic sexual intercourse. Interestingly, this picture is not only seen in women, but also in men. The exact definition according to ICD 10 (see explanation above) also shows the first differences to vaginismus:

ICD-10 Code F52.6 : Nonorganic dyspareunia
«Dyspareunia (pain during sexual intercourse) occurs in both women and men. It can often be attributed to a local pathological process and should then be classified under the corresponding disorder. This category should only be used if no other primary non-organic sexual disorder is present (eg vaginismus or lack of vaginal lubrication).

Differences between dyspareunia and vaginismus

I hope I was able to make it clear that the problem of distinguishing between vaginismus and dyspareunia only concerns the non-organic form.
In both functional disorders, the muscles are the cause of the symptoms, more specifically the pelvic floor muscles: In vaginismus, they cramp involuntarily, hence the colloquial term “vaginal spasm”.
All information about vaginismus / vaginal cramps can be found at: https://theros.de/blogs/ratgeber/scheidenkrampf

The cause of non-organic dyspareunia is often excessive muscle tone. For many years, problems with the pelvic floor were associated with muscle weakness. Experience and studies have now shown that many pelvic floor problems are caused by muscles that are too tight, too much tension and too little flexibility. The reasons for the frequent occurrence of this phenomenon today can be assumed to be the great social pressure and the speed associated with it. The main cause of non-organic dyspareunia is therefore excessively tense, even cramped muscles: despite existing lubrication (vaginal moisture), penetration into the vagina is impossible or very difficult, causing pain during sex through penetration. The experience of painful penetration of the penis into the vagina can then trigger an ever-increasing spiral of fear and pain. This in turn affects the arousal of the affected woman, which often becomes weaker and weaker and can even disappear completely.

Diagnosis of dyspareunia

In practice, there are often cases of pain during sex that cannot be clearly identified. In addition, not every gynecologist is well-versed in the subject. Interdisciplinary cooperation between gynecologists, possibly also dermatologists and urologists, sexologists and muscle specialists is useful in order to achieve the most specific diagnosis possible and successful treatment.
With regard to organic dyspareunia, the first step is to cure the physical symptoms. Another important aspect is to explain the complexity of this dysfunction to the women affected. Many patients only want to see the cause on a physical level. They must first be persuaded to accept the psychological component as well.

treatment of dyspareunia

In order to be able to start an effective treatment, it is often a good idea to abstain from sexual intercourse for a certain period of time in order to no longer experience the pain during penetration and to forget it as much as possible. On the one hand, to give the physical symptoms a chance to heal without further stress, and on the other hand, to work on dissolving the pain-fear spiral.

The following is a summary excerpt from a scientific text by Dr. Karoline Bischof, gynecologist and sexologist, Zurich:
" Women with chronic dyspareunia seem to have a tendency to process pain differently than those without it: pain is seen as particularly bad. There is anxiety and hypervigilance or hypersensitivity to pain (comparable to fibromyalgia patients and others). Roughly speaking, one can say that they have a tendency to over-estimate pain-related symptoms and, in particular, feelings of helplessness.
An important element of therapy is desensitization and resensitization. This means that the woman learns to isolate the painful regions of her genitals and to trigger sensory sensations other than pain through regular gentle touches with care products - initially neutral, then increasingly pleasant sensations, and over time also sexual arousal. An essential prerequisite for this is the use of movement and relaxation in the pelvic floor, and over time also abdominal breathing, pelvic circles and pelvic rocking, since the high muscle tension is such an essential element in the genesis of pain. "

It is also important to examine your sexual biography and identity : How did I experience being female and how do I feel about it? What values ​​are associated with it? Do I accept my gender? Do I enjoy touching, looking at and smelling myself?

Another important point in the treatment of dyspareunia is to learn to perceive the pelvis and especially the state of muscle tension .

To treat the symptoms on a physical level, I recommend loosening the tissue with Theros® FMS dilators based on nature's example.

And with Theros® vaginal stents you can make the treatment success of FMS dilators more sustainable.

Learning new, flowing, soft movements is also part of loosening the pelvic floor. This should be done as part of a comprehensive therapy.

For your mind and psyche, I recommend relaxation exercises in the form of meditation, breathing exercises and/or fantasy journeys. With my holistic therapy approach, I would be happy to be your “ travel companion as a therapist ”, give you guidance and guide you (and your partner) through this process.

On the topic of "Pain during sex you might also be interested in:

• Guide to Vaginismus and Vaginal Cramps
• Guide Lichen sclerosus

Are you interested in other topics? Here you can find all of Theros®'s guides .