There dispareunia It indicates a painful condition perceived by the woman in the vagina or pelvis area during sexual activity.
Unlike the vaginism that is the persistent and recurring difficulty, by the woman, to accept the vaginal penetration despite the desire to do so and often associates with phobic avoidance and the anticipatory fear of pain, dyspareunia is a pain that is felt during the relationship.
It has implication for the quality of life, not only of the woman but also of the couple. Sometimes there is a sense of shame to communicate this type of disorders to the doctor. Despite being mostly considered a female disorder, the dispareunia It can also concern men.
The moment of onset of pain represents a fundamental element to classify the dyspareunia: we speak of primary dyspareunia (also called lifelong or permanent) when the pain during penetration is presented from the beginning of sex life and of secondary dyspareunia or acquired when the disorder manifests itself after a period of normal sexual functioning.
It can also be identified whether the disorder is situational (when pain occurs only with a certain type of stimulation, in certain contexts or with certain partners) or generalized (when the pain is present constantly both over time and the change of the partner).
The location of pain is necessary to distinguish Different types of Dispareunia. Depending on the headquarters of the pain, we speak of superficial dyspareuniawhen the pain is identifiable to the intake or in the first vaginal tract and of deep dyspareunia When the disorder manifests itself with complete penetration. The study of the location of coatal pain represents a central factor to understand the etiology of Dispareunia.
Causes of Dispareunia
Several factors can be involved in the Dispareunia: physicists, psychological and relational.
Among the Physical causes of Dispareunia Superficial we find the infectious or inflammatory (e.g. vulvar vestibolitis), hormonal (e.g. reduction of lubrication and vaginal atrophy in menopause), muscle (hyperactivity of the anus elevator muscle) and iatrogene (drugs and outcomes of surgery).
Among the biological factors which cause deep dyspareunia, endometriosis and pid (pelvic inflammatory disease) is highlighted.
In Dispareunia there may be psychosexual causes and they can coexist more sexual dysfunctions such as, for example, vaginism, the decrease in excitement, the fall of desire, etc.; To be added, relationships and problems with the partner who also affect sexual satisfaction can also come into play.
Care of Dispareunia
The identification of the causes of the disorder can direct the doctor in choosing the most appropriate therapy treatment for the patient. Lubricants are useful for reducing burning and vaginal dryness and improve symptoms in many women but do not deal with the physiological changes that are the basis of the most frequent type of dyspareunia, the one that occurs in post-Menopause and which is rather treated with estrogen-based treatments.
There psychological therapy aimed at resolving Dispareunia, it turns out to be an effective treatment if oriented to renovate the dysfunctional thoughts of the woman who very often affect sexual life negatively. Avoid sexual intercourse, to escape possible intimacy situations with the partner and the abuse of anxiolytic drugs have not contributed to the resolution of the disorder.
It is necessary to make a serious evaluation of any states of anxiety and depression and consider that the sexual pain It is affected by the relationship that we have with our body. The psychotherapist is often faced with women who for a long time have felt this pain denying that he was only psychological. This attitude has increased guilt, general anxiety and a experience of sexual inadequacy in women with an increased risk of reactive depression.
Pain cannot be considered and must be understood by investigating first of all the biological and then psychic causes; Making a careful diagnosis avoids getting lost in attempts that only increase the feeling of uselessness of the care.
On the dyspareunia it is easy to find how influential arepressive or too rigid education. Some women present a difficulty in dealing with topics related to their sexuality due to the fear of being considered dirty or little serious. Furthermore, anxiety does not help the indispensable abandonment for a serene and free relationship, as well as influencing the fear of not liked the partner or not to be adequate for the situation.
Furthermore, for younger women, aspects of psychosexual immaturity. Sometimes, in fact, the origins of Dispareunia are hidden in early relationships, hasty preliminaries that do not promote the emotional abandonment necessary for sexual intercourse.
One of the main factors of maintenance of the disorder is the lack of a timely diagnosis of the first symptoms of pain. From a psychological point of view, enduring pain is a serious mistake because it creates a memory of the pain itself that increases anxiety. The central point is that genital pain can be caused by organic factors but can increase for psychological reasons. It is therefore essential intervene promptly With a medical examination, even better if the reference gynecologist is also a sexologist.
Psychotherapy for Dispareunia
Highlighted the biological bases of pain, which can be very varied, and the woman’s clinical history is deepened, one can think of one individual psychotherapy or couple.
One of the first objectives of psychotherapy is to strengthen women’s self -esteem: the dispareunia It is in fact a multifactorial disorder and therefore, almost always, the therapist collects stories already proven by continuous medical visits and treatments.
The therapist is available to welcome fears and sensations that are often not addressed within the medical examination due to the most narrow times. Psychotherapy aims to work on self -esteem, self -awareness and anxiety.
The repeated experience of pain during coitus can cause theavoidance of sexual experiencesthe impairment of existing sexual relationships or the limitation of new sexual relationships.
If the Dispareunia is consequent to psychological causes, they are indicated:
- Psychoeducation: Knowledge of sexual anatomy and the sexual response cycle, improvement of awareness of one’s body (through visual exploration and behavioral prescriptions), understanding of the physiological and psychological factors involved in sexual relationship, examination of beliefs and common myths inherent in sex, etc.;
- Cognitive-behavioral psychotherapy: The aim of questioning automatic thoughts and erroneous beliefs relating to the theme of control and catastrophic cognitive style is aimed at questioning. This change allows good management of anxiety through the application of some homework and relaxation techniques that go to improve control over the vaginal muscles (for example Kegel exercises to tone and strengthen the muscles that form the pelvic floor), reducing pain and making sexual intercourse more pleasant. These practices can also be adopted within a couple therapy and be carried out together with your partner, whose participation can contribute to the success of the treatment.
It is still to be underlined how in this specific disorder it covers the consultation phase with the specialist more than ever importance, in order to understand the signal value that the sexual symptom, intended as communication, represents and seek the most suitable therapeutic path to the individual case.
