Painful Intercourse (Dyspareunia)
Dyspareunia is defined as persistent or recurrent genital pain that occurs before, during or after intercourse. The pain can be on the external surface of the genitalia or deeper into the pelvis. Dyspareunia is significantly more common in women than men and it occurs most frequently in the postpartum and peri/postmenopausal years.
Post Partum Dyspareunia
A recent study in BJOG noted that at 18 months postpartum, 24% of the 1211 women in the study reported persistent dyspareunia. They also noted that women who had obstetric intervention such as sutured tears, caesarean section and vacuum extraction had increased odds of reporting persistent dyspareunia at 18 months postpartum.1
Peri/Postmenopausal Dyspareunia
Pain during sexual intercourse is one of the most common complaints in aging women. In a large-scale population study the prevalence was shown to range from 2-29%. Dyspareunia contributes to a poorer quality of life in both younger and older women. In menopause, changes in hormone levels can lead to vaginal atrophy. Pelvic floor muscles start to work harder to prevent leakage of urine and stool and they can become tight and stiff leading to pain on penetration.
Treatment
Treatment is determined by the underlying causes. A complete assessment can help to identify issues that may be contributing to the problem. Physiotherapy treatment can include learning how to control the contraction and relaxation of muscles as well as myofascial techniques to stretch scarring and release tight muscles.
Footnote
- McDonald EA,Gartland D,Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015;122:672–679.