Pretty girl Rena came to see me in my office upon return from her honeymoon, she was in tears, this honeymoon was a total disaster, as they could not enjoy or have any sexual entertainment or pleasure.
Dyspareunia means painful sex, and the word is derived from Greek, which means (Badly Mated).
When you cannot have sex at all is called Apreunia.
Vulval pain is in fact quite a common condition, more often occurring in women, almost one in four women suffer with Dyspareunia during there life span.
Historically it was described in 1880 as hypersensivity or super sensitivity of the vulva. It was in 1975 that the Vulvovaginal Disease Society gave it a name , burning vulva syndrome.
We have come a long way in understanding the problem , however we do not totally understand what causes it. In the past the condition was considered to be psychological, however luckily for the modern women the current diagnostic and therapeutic approach is integrated with some psychology.
Dyspareunia is a complex problem and frequently has a multifactorial aetiology. A new way has been recently suggested to define dyspareunia by dissecting it into primary, secondary, and tertiary sources of pain. It is also defined into superficial or deep depending on the origin of the pain and these will be discussed in future blogs.
We are talking about pain in the female external genitalia which lies between our thighs, and it is called the Vulva.
As a result of the pain the muscles of the area go into a spasm, and this is then called vaginismus.
Vaginismus can often happen before the sex is initiated, due to fear or psychological reasons.
Dyspareunia can be superficial, due to the visible structures or deep within the vaginal area.
In this post we will concentrate on some of the superficial causes of pain. We will not talk about the skin conditions, such as infections, dermatitis, herpes, human papilloma virus, congenital abnormalities such as the vaginal septum's, tough hymen, absent hymen or even absent vagina. Hymen is a membrane with a small opening in the centre , through, which the menstrual blood flows. At the time of commencement of sexual activity, the penis goes through the hymen, enlarging the opening.
Sometimes if this is not possible a medical procedure is necessary to enlarge it.
This type of difficulty along with painful infections or fear, disparity between the size of the mans penis and vagina, the vulva goes into a muscular spasm, this is very painful and some times extends into the women's legs.
Women coming from very conservative families , lack of education and abuse as a child, along with
local operations on the vulva and traumatic child birth, also get vaginismus.
So as medical practitioners after taking a detailed history and clinical examination should then advise the treatment accordingly.
The simplest thing to start with is to give basic education on sexual intercourse, reassurance, and some antidepressants.
Physiotherapy of the pelvic floor is useful.
It the vaginismus is not to severe you can help, by teaching the patient how to dilate the vagina. The vagina should be well lubricated, watery lubricants should be used. In my experience I have found Olive Oil to be a very good lubricant. The women should avoid using off the counter preparations, such as strong soaps, talcum powder or perfumes. The best thing to wash is with plain clean water.
The dilators are available as a set of gradually increasing size and the women can lubricate it slowly in the shower.
In very severe cases of vaginismus where the sex is totally impossible the treatment has to be taken.
One of the best treatments was described by Master and Johnson in 1970, still makes great sense to me. There advise that the couple should have a peaceful time to have relationship, initially they should touch each on non sexual organs, taking it in turns as to who starts first. There is total ban on sexual activity until the women is totally relaxed. There should be a fair bit of foreplay until she is well lubricated. The sexual activity should start with regular gentle stretching.
This condition is almost always reversible.
The next important condition causing superficial Dyspareunia is currently named Vulvodynia and we will talk about this in the next blog.
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