Human sexual activity, human sexual practice, or human sexual behaviour is the manner in which humans experience and express their sexuality. Humans indulge in sexual activity for either reproductive, relational, or recreational purposes. Whatever the purpose, sexual activity definitely has a significant impact on a person’s psychosocial and personal development. Sexual activity can lower blood pressure and overall stress levels, regardless of age. It serves to release tension, elevate mood, and possibly create a profound sense of relaxation, especially in the postcoital period. From a biochemical perspective, sex causes the release of endorphins and increases levels of white blood cells that actually boost the immune system.
Sexual dysfunction is the inability to react emotionally or physically to sexual stimulation in a way projected of the average healthy person. It can affect both men and women. Female Dyspareunia (Painful intercourse) is a type of sexual dysfunction which is more common in women. Nearly one in 10 women suffer from dyspareunia. This profoundly can affect a woman psychosocially which can have an impact on the whole family as the pillar of strength for every family is a woman.
What is Dyspareunia?
In one word, if you have to describe Dyspareunia, it’s unpleasurable. Dyspareunia means recurring pain in the vaginal area or within the lower abdomen during or after sexual intercourse. The pain can be sharp or intense. It can occur even before intercourse especially with the thought of sex in some females.
Common causes of dyspareunia include:
- Congenital (from birth) or structural abnormalities like vaginal septation (bridge dividing the vagina) or Pelvic organ prolapse (bulging or descent of organs)
- Vaginal skin disorders like ulcers, cracks, itching, or burning which can cause inflammation of the vagina
- Injury or trauma from childbirth, an accident or pelvic surgery
- Introital infections
- Vulvodynia, or pain centered in the vulva area
- Pelvic floor dysfunction
- Vaginal dryness and less lubrication from menopause, childbirth, breastfeeding, medications, or too little arousal before intercourse
- Vaginismus, or a spontaneous tightening of the muscles of the vaginal wall
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Irritable bowel syndrome (IBS)
Risk factors that reduce sexual desire or affect a person’s ability to become aroused can also cause dyspareunia. These factors include:
- Age and menopause
- Fear, guilt, or shame related to sex
- Physical or mental stress,
- Self-image or body issues
- Relationship or affair problems
- Medical conditions like Diabetes, thyroid disease
- History of sexual abuse or rape
It all starts with some inciting factor or event. Sex becomes initially painful due to the various psychological or physical factors mentioned above. If treatment is not sought early on, it enters the cycle of pain (See figure). This keeps on progressing which can cause dire consequences.
The common problems why females don’t seek for treatment are fear, shyness, and anxiety, social and cultural reasons. This is also because they want to hide their symptoms so that their male partners are left satisfied in spite of them suffering. There should be no reason to avoid medical treatment as dyspareunia can definitely be treated. These women can consult a Gynaecologist or a Urogynaecologist without wasting much time.
Diagnosis: Evaluation for dyspareunia usually consists of
- A detailed medical history. Your doctor might ask when your pain began, where it hurts, how it feels, and various other personal questions. Your doctor might also inquire about your sexual history, surgical history, and childbirth. Don’t let embarrassment stop you from answering truthfully. These questions provide clues to the cause of your pain.
- A Pelvic examination. During a pelvic examination, your doctor can check for signs of skin irritation, infection, or structural problems. He or she might also try to locate the exact site of pain by applying gentle pressure to your genitals and pelvic muscles.
- Your doctor might ask for an ultrasound, blood, and urine tests.
Various treatment options available:
- Treatment and control of associated medical conditions
- Antibiotics and Antifungals for treatment of infection
- Medications to alleviate pain and anxiety
- Detailed psychosocial counseling
- Identification and treatment of stressors
- Pelvic floor physiotherapy and relaxation exercises
- De-sensitisation therapy by relaxing vaginal muscles
- Use of water-soluble lubricants for dryness
- Topical oestrogen creams in older woman to improve vaginal softness
- Consensual sex when you and your partner are relaxed
- Communicate openly with your partner about your pain
- Empty your bladder before sex