Dyspareunia is defined as painful intercourse. It can occur before, during, or after sex. Causes include insufficient lubrication, injury or inflammation, vaginismus, and certain medical conditions. Physical factors like lack of arousal can cause entry pain, while deep pain may be from conditions that involve the pelvis. Emotional and psychological issues as well as past trauma can also contribute. Treatment focuses on the underlying cause, and lifestyle changes like switching positions, communicating, taking time with foreplay, and using lubricants can help reduce pain.

1. Senior Nurse Lecture
Series
Dyspareunia

2. DEFINITION
• The medical term for painful intercourse is dyspareunia
— which is defined as persistent or recurrent genital
pain that occurs just before, during or after intercourse.
Talk to your doctor if you're experiencing painful
intercourse. Treatments focus on the underlying cause,
and can help eliminate or reduce this common problem.

3. SYMPTOMS
If you experience painful intercourse, you may feel:
• Pain only at sexual penetration (entry)
• Pain with every penetration, even while putting in a tampon.
• Pain with certain partners or just under certain circumstances.
• New pain after previously pain-free intercourse.
• Deep pain during thrusting, which is often described as "something
being bumped"
• Burning pain or aching pain

4. CAUSES
•Physical causes of painful intercourse tend to
differ, depending on whether the pain occurs
at entry or with deep thrusting. Emotional
factors can be associated with many types of
painful intercourse.

5. LOCATION OF PAIN
Entry pain
•Pain during penetration may be
associated with a range of factors.

6. FACTORS OF ENTRY PAIN
• Insufficient lubrication. This is often the result of not enough
foreplay. Insufficient lubrication is also commonly caused by a
drop in estrogen levels after menopause, after childbirth or during
breast-feeding. In addition, certain medications are known to
inhibit desire or arousal, which can decrease lubrication and
make sex painful. These include antidepressants, high blood
pressure medications, sedatives, antihistamines and certain birth
control pills.

7. FACTOR OF ENTRY PAIN
•Injury, trauma or irritation. This includes
injury or irritation from an accident, pelvic
surgery, female circumcision, episiotomy or a
congenital abnormality.

8. FACTORS OF ENTRY PAIN
• Inflammation, infection or skin disorder. An
infection in your genital area or urinary tract can
cause painful intercourse. Eczema or other skin
problems in your genital area also can be the
problem.
• Vaginismus. Involuntary spasms of the muscles of
the vaginal wall (vaginismus) can make attempts at
penetration very painful.

9. LOCATION OF PAIN
Deep pain
•Deep pain usually occurs with deep
penetration and may be more pronounced
with certain positions.

10. FACTORS OF DEEP PAIN
•Certain illnesses and conditions. The list
includes endometriosis, pelvic inflammatory
disease, uterine prolapse, retroverted uterus,
uterine fibroids, cystitis, irritable bowel
syndrome, hemorrhoids and ovarian cysts.

11. FACTORS OF DEEP PAIN
•Surgeries or medical treatments. Scarring from
surgeries that involve your pelvic area, including
hysterectomy, can sometimes cause painful
intercourse. In addition, medical treatments for
cancer, such as radiation and chemotherapy, can
cause changes that make sex painful.

12. EMOTIONAL FACTORS
• Psychological problems. Anxiety, depression, concerns about your
physical appearance, fear of intimacy or relationship problems can
contribute to a low level of arousal and a resulting discomfort or pain.
• Stress. Your pelvic floor muscles tend to tighten in response to stress in
your life. This can contribute to pain during intercourse.
• History of sexual abuse. Most women with dyspareunia don't have a
history of sexual abuse, but if you have been abused, it may play a role.

13. LIFESTYLE CHANGES & REMEDIES
• Switch positions. If you experience sharp pain during thrusting,
the penis may be striking your cervix or stressing the pelvic floor
muscles, causing aching or cramping pain. Changing positions may
help. You can try being on top of your partner during sex. Women
usually have more control in this position, so you may be able to
regulate penetration to a depth that feels good to you.

14. LIFESTYLE CHANGES & REMEDIES
• Communicate. Talk about what feels good and what
doesn't. If you need your partner to go slow, say so.
• Don't rush. Longer foreplay can help stimulate your
natural lubrication. And you may reduce pain by
delaying penetration until you feel fully aroused.

15. LIFESTYLE CHANGES & REMEDIES
• Use lubricants. A personal lubricant can make sex
more comfortable. Read labels carefully or ask
your doctor to recommend a product to try; for
some women, personal lubricants that contain
glycerin can promote yeast infections.

16. COPING AND SUPPORT
• Until vaginal penetration becomes less painful and
bothersome, you and your partner might find other
options to be more comfortable, more fulfilling and
more fun than your regular routine. Sensual massage,
kissing and mutual masturbation can all be good
alternatives to intercourse.

17. THANK YOU VERY MUCH
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Of
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