Female Sexual Dysfunction, Part 2
It often saddens me when I see a young couple, newly married, struggling to establish an intimate, sexual relationship because of pain. Pain during sexual intercourse is a complex condition. There are usually both emotional and physical components to this condition. It is imperative to understand the physical component and assertively confront the emotional component in order to move towards an enjoyable sexual relationship.
According to the American College of Obstetrics and Gynecology (ACOG), there are two common types of sexual pain, dyspareunia and vaginismus. Vaginismus is a repetitive and constant muscular spasm of the outer portion of the vagina. Dyspareunia is pain resulting from sexual intercourse. It is repetitive and constant and not related to vaginismus. Dyspareunia is also not related to a lack of lubrication. Both forms of sexual pain cause suffering or challenges within the relationship.
With dyspareunia, the pain is reproducible on exam. We often exam these patients with the use of a Q-tip. A speculum is inserted into the vagina and, then, the Q-tip is touched to certain areas within the vagina and a positive result occurs at the point(s) when the patient complains of pain. Another examination technique may be with use of a finger instead of a Q-tip. Other disorders often associated with dyspareunia include lack of arousal or hyposexual desire disorder.
Vaginismus is not as common as dyspareunia. It can occur when a woman is simply anticipating sexual intercourse. There may be fear associated with the anticipation and, as a result, sexual intercourse is not possible due to the pain associated with penetration. Sexual dysfunction disorders associated with vaginismus include hypoactive sexual desire and sexual aversion disorder.
The description of sexual pain disorders described above are taken from an article entitled, Female Sexual Dysfunction, an April 2011 ACOG publication. Because of the experiences that my patients share with me and after reading excerpts from a book entitled, When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain, I was inspired to write on the subject of sexual dysfunction. This book is a nice simplified yet comprehensive discussion of the subject of sexual pain. (Once again, I do not have any special interest in this book. I will not personally gain if you purchase this book. )
Understanding the name of your condition is only the start of a long journey. If you are experiencing a sexual pain disorder, I am sure you are wondering what you can do about it. First, you must become open to the possibility – the possibility of an intimate, fulfilling relationship. Achieving this goal will require some work.
1. Discuss your condition openly with your spouse. Pain without a visible injury can often be difficult for others to understand.
2. Try to find a health care provider who has an interest in the diagnosis, evaluation, treatment and management of sexual pain disorders.
3. Be patient with your evaluation. Your health care provider must first evaluate you for any other causes of sexual pain, such as infection.
4. Your treatment and continued management will likely involve a multidisciplinary team of professionals. This may include not only a physician but also a physical therapist and a counselor or psychologist. Prior to your first appointment with your health care provider, I encourage you to begin researching the specialists in your area that have expertise in treating sexual dysfunction.
5. Be prepared to give a detailed sexual history. This may involve revisiting painful memories from the past. Your honesty, openness and trust will be paramount to your healing.
6. Prior to your appointment with a health care provider, think about what triggers the pain. What makes the pain better? Does changing your sexual position diminish the pain? What makes the pain worse? Where is the pain exactly? Is the pain deep inside your vagina? Is the pain in your pelvis?
7. Lastly, begin to visualize yourself in a healthy, sexual relationship. Visualize yourself breaking through emotional and physical barriers to intimacy.