The technical term, dyspareunia, comes from a Greek word (don’t they all!) “dyspareunos”, which means “badly mated”. Those who suffer from this malady can confirm that pain every time you have sex creates “bad mating” as well as other problems. The first step in solving this dilemma is properly identifying the factors that play a role. As I mentioned, this is a much more common occurrence in the menopause, although it definitely can occur at other seasons of life. After menopause, either natural or surgical, estrogen levels decline and periods cease. The cells that line the vaginal walls are very hormone sensitive tissues, and with a lack of hormones, the normally thick and lush epithelium (lining cells) can become thin and much less elastic. Over time this results in dry, less pliable tissue that can cause a variety of symptoms. The old terminology for this problem was atrophic vaginitis, however this has been revised to genitourinary syndrome (GS) to properly encompass the potential wide ranging nature of the problem. The tissues of the vagina, vulva, and bladder can all be effected as they are all dependent on estrogen for continued proliferation and lubrication.
Potential symptoms of GS include:
Burning and irritation of reproductive organs and structures
Dryness, discomfort, or pain with intercourse
Urinary urgency
Dysuria(pain with urination)
Recurrent infections.
It is important to remember that not all women will be afflicted with this problem, and some women will only manifest a single symptom. Nevertheless, GS is the leading cause of painful intercourse in peri and postmenopausal women.
So what’s a girl to do?
There is a class of medicines called SERMs (selective estrogen receptor modulators) that are used to help vaginal dryness and pain with sex. One in particular has been approved for this use, but again there are potential side effects to be considered.
A relatively recent and novel approach is to use a CO2 laser to stimulate collagen and epithelial growth essentially “rejuvenating” the vaginal tissue and eliminating or lessoning the pain symptoms. This is a painless office procedure that has been extremely successful in clinical trials in improving lubrication, decreasing pain with sex and aiding elasticity.
In addition to menopause, various other causes can be responsible for painful intercourse. Any type of vaginal infection can temporarily create irritation and pain. Obviously treating the infection is key to resolution. Scar tissue in the pelvis from prior surgery or infections can do the same. Urinary tract infections (bladder infections) and even chronic antihistamine use (drying of the vaginal tissues) can be culprits. There is a relatively rare condition called vaginismus where a woman experiences involuntary muscle contractions in the vaginal wall while attempting sexual relations which results in pain and an inability to allow penetration.
This common problem can be adequately addressed in most situations and it is a matter of telling your doctor about your symptoms and together seeking a solution.
