| The female dyspareunia: understand and treat
An original article Dr Sandrine Atallah, MD, Sex Therapist, hypnotherapist
WHEN LOVE IS PAINFUL: Love is synonymous with
physical pleasure and relaxation, and yet…
Indeed, love and sexual encounters are supposed to be a source
of well-being and not pain. However, statistically for 15 to 20%
of women aged from18 to 45 years, painful intercourse is the rule,
not the exception.
The dyspareunia: this pain felt during penetration or during
movements goings of the penis into the vagina is a frequentcomplaint
.. If pain occurs at the beginning of penetration, this is called
superficial dyspareunia. If pain only appears in a deep penetration,
dyspareunia is called deep.
The cycle of pain
This pain has no place in a fulfilling sex life and should not
be tolerated. Many women do not care about this symptom in the
early stages and gradually leave it invade their sexuality and
chew their desire until it is extinguished. Others allow their
doctor or their entourage to convince them that everything is
"in the head".They feel guilty because they believe
they are the source of their suffering and so, avoid intimate
contact… We have to remember that painful experience leads
to a fear of its recurrence and generates a anticipating pain
stress … Thus, the encounter with the beloved is no longer
a source of exchange and loving, but of fear. Moreover, the apprehension
of pain leads to a generalized muscle contraction, especially
the muscles of the pelvic floor. This contraction causes pain
, makes penetrations difficult, leads to weak arousal and poor
lubrication :any sensation of pleasure is then impossible. The
emotional anxiety generated by this spiral, increases pain. It
is worth pointing out that the climate will often find relational
disrupted, which increases even more stress. Thus, the woman is
trapped in the cycle of pain that psychologically leads to a decline
in self-esteem; decreased libido may even lead to depression.
Lies or silence do not preserve the couple and the relationship,
but amplifies suffering.
Easily identifiable causes
But the causes of dyspareunia are usually easily diagnosable and
treatable, in fact, dyspareunia is not a disease in itself but
a symptom of a malfunctioning. The latter can be both organic
and / or order psycho-relational.
There are mundane reasons such as insufficient preliminary or
a lack of desire that prevent proper lubrication and muscle relaxation
necessary for an easy and pleasurable penetration.
In addition, the origin of the pain may be organic (gynecological,
urinary, vascular, dermatological, ligament) or psychological.
Often several factors interact, because of the loss of self-confidence
and guiltness which take over if the organic factors have
lasted. Similarly, the quality of the relationship within marriage
is very important: communication, trust and respect are essential
to great sex. Finally, the personnal experience, history,
and morals and affects every woman giving a particular emotionnal
color to her sexuality. Thus, in a very strict and culpability
centered education, strong social pressure and / or family, but
also severe psychological trauma (rape, incest…) can lead
to severe dyspareunia.
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Different
dyspareunia
The pain at the beginning of the penetration
The pelvic exam can diagnose and treat a urinary infection vulvo-vaginale
or (cystitis, thrush, a TSI: virus (herpes) or bacterial), dermatitis
(eczema, lichen), congenital malformations (abnormal hymen, malformation
of the vagina), trauma (following childbirth), an episiotomy badly
healed , surgical trauma (surgery for cancer of the uterus), the
injury to a sexual trauma (injury penetration, cracks).
Pain in the deep penetration
There are mostly gynecological diseases: high genital infection
(in the uterus, ovaries and fallopian tubes) or its aftermath,
fibroids and voluminousovarian cysts, endometriosis (sterility,
significant pain during menstruation), surgical treatment , lesions
of the cervix.
"The monologues of the vulva"
Many unknowns remain, and myths around pain and diseases of the
vulva both psychological and physical factors interfere and mix.
It is however necessary to highlight a few important concepts
The vestibulitis:
It is a superficial dyspareunia located at the entrance to the
vagina, in the vestibule (inside the labia minora and vaginal
opening) and the range vulvar. Women suffering from vulvodynie
feel a burning, feelings of knife wounds or tearing where penetration
of the vagina (penis, finger,tampon, and so on.). For some, the
pain is also when wearing tight pants or string.
Often misdiagnosed because the vulva looks quite normal (there
are sometimes a little redness) vestibulitis, is real and painful.
Indeed, the gynecologist with a cotton swab can identify sore
spots common to all patients.
The causes of the disease are unknown, but several hypotheses
are under study seeking an inflammation or hyperalgesia nerves
in the region in question. It is often associated with other chronic
diseases such as fibromyalgia, irritable bowel syndrome and interstitial
cystitis.
- 1. The vestibulitis is one of the most frequent reasons for
consultation
- 2. This is neither a sexually transmitted infection nor a
cancer or a sign pre -
- 3. The vestibulitis is not an incurable disease
- 4. there is no miracle recipe to cure vestibulitis (like those
found in the women forums on the web)
- 5. The vestibulitis not an "illness in the head."
A treatment addressing organic, emotional and psychological aspects
is the most efficient. So, can be associated guidance for good
feminine hygiene and analgesic creams or gels to antidepressant
treatment (in the case of mood disorders), or a physical or relaxation
even hypnosis. A couple therapy as short or cognitive-behavioral
therapy could be of great value.
Persistence of dyspareunia after medical treatment of
the cause
The most of dyspareunia has an organic cause at starting point
. But what must be understood is that after medical treatment
of the dyspareunia cause , there may be a phenomenon of pain conditioning.
This conditioning in pain at each intercourse, leads to apprehend
penetration, and causes an involuntary contraction of the muscles
surrounding the vagina, penetration is then painful , pain that
has no more an organic origin, but psychological!
Residual Dyspareunia treatment the will be based on the principle
of behavioral therapies, which consist of a gradual desensitization
of the fear of pain during penetration, coupled with a training
of muscles of the pelvic floor.
This work, step by step, will decondition the woman of her apprehension
of pain, and gradually will eliminate pain felt during penetration.
The involvement of the partner is recommended.
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