The female dyspareunia: understanding and treating it
An original article Dr Sandrine Atallah, MD, Sex Therapist, hypnotherapist

WHEN LOVE IS PAINFUL: Making 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.

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, it is called superficial dyspareunia. If pain only appears with a deep penetration, then it 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 kill their desire until it is extinguished. Others allow their doctor or their entourage to convince them that everything is "in the head".These womenfeel guilty because believing 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 an 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 deficient 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 relational climate will often be disrupted, which increases even more stress. Thus, those women are trapped in the cycle of pain that psychologically leads to a decline in self-esteem; decreased libido and 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 benign reasons such as insufficient preliminary or a lack of desire that prevent proper lubrication and muscle relaxation which are necessary to 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

Different dyspareuniae

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), injuries due to sexual trauma (injuries due to penetration, cracks).

Pain with the deep penetration
There are mostly gynecological diseases: upper 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 and myths remain 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 have burnings, feelings of knife wounds or tearing at penetration (by penis, finger, tampon, and so on.). For some, wearing tight pants or string is also paiful.
Often misdiagnosed because the vulva looks quite normal (there are sometimes a little redness), vestibulitis is real and painful. Indeed, the gynecologist can identify with a cotton swab sore spots common to all patients.
The causes of the disease are unknown, but several hypotheses are under study seeking for an inflammation or hyperalgesia of nerves in the concerned region. 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 of consultation
• 2. The vestibulitis is not a sexually transmitted infection, neither a cancer nor a sign of meadow cancer.
• 3. The vestibulitis is not an incurable disease
• 4. there is no miracle recipe to cure vestibulitis (like those found in women's forums on the web)
• 5. The vestibulitis is not an "illness in the head."

A treatment combining 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 physiotherapy or relaxation even hypnosis. A short couple's therapy or cognitive and behavioral therapy could be of great value.