الجماع المؤلم (عسر الجماع)

What is dyspareunia?

Dyspareunia (painful sex) is a recurrent or continuous pain in the genital or pelvic region, during or after sex. It is quite common in both men and women and can be caused by a variety of things, including an infection, or physical and psychological problems.

A recent survey has found that 1 in 13 women in the UK experiences painful intercourse. It is important that those who have recurrent pain during sex should speak to a specialist. Men can also experience dyspareunia but it is more common among women.

What are the symptoms of dyspareunia?

In women

Female dyspareunia may cause the following symptoms:

• pain only with sexual penetration
• pain with every penetration – including inserting a tampon
• burning or aching sensation
• throbbing pain – hours after intercourse
•  

In men

The symptoms of dyspareunia in men include:

• continuous pain in the genital or pelvic region – present during and after intercourse
• burning sensation
• irritated skin
• inability to be aroused
•  

What are the causes of dyspareunia in men and women?

The causes of dyspareunia can vary and there are numerous potential reasons. There can be pain upon entry during penetration, which may be associated with a lack of lubrication. Injury or irritation from an accident, pelvic surgery, circumcision, or a cut made during childbirth to make the birth canal larger, may also cause painful intercourse.

Other factors associated with dyspareunia include inflammation, a urinary tract infection, sexually transmitted diseases such as chlamydia or gonorrhoea, eczema on the genitals or vaginismus in women.

Deep pain caused by certain conditions such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis, cysts and piles can also lead to dyspareunia. Other medical treatments such as a hysterectomy or chemotherapy for cancer may also lead to painful sex.

There are emotional factors, such as anxiety, depression and fear of intimacy that can contribute to lack of arousal, which results in discomfort when trying to have sex.

Can dyspareunia be prevented?

Preventing painful sex depends on what the cause is. There are a few things that can be done to prevent some cases, such as:

• increased foreplay for natural lubrication
• use oestrogen preparations if postmenopausal
• use contraceptives for safe sex to prevent an STI
•  

What is the treatment for dyspareunia?

The treatment will vary depending on each patient and the individual case. A medical evaluation with a gynaecologist or urologist consists of a pelvic examination, where the doctor can check for pain, skin irritation or anatomical problems. There may also be a pelvic ultrasound. Some patients may need to have counselling or sex therapy if there are emotional reasons behind dyspareunia.

Others may need to take medications to clear any infections, such as antibiotics to treat chlamydia or to change some medications that they are already taking, which may be affecting the patient’s natural lubrication.