Dispareunia is persistent or recurrent pain associated with the sexual act.
Vaginismus is the persistent or recurrent involuntary spasm of the musculature in the external third of the vagina which interferes with vaginal penetration, leading to personal distress (anxiety, frustration, angst).
Persistent or recurrent genital pain unrelated to coitus may also present.
Muscular spasm is generally activated by psychogenic factors such as fear, disgust or anxiety when simply thinking about penetration.
The pain unrelated to coitus may be referred to the clitoris or the vestibular area.
Dispareunia affects approximately 15% of sexually active women and 30% of post-menopausal women. Vaginismus is present in 0.5-1% of fertile women.
Vaginal receptivity is fundamental for coitus, requiring the anatomical and functional integrity of the tissues, vessels, nerves, hormones, etc. modulated by psychosexual, mental and interpersonal factors. Fear of penetration may lead to defensive contraction of the perivaginal muscles, leading to vaginismus. The contraction of pelvic floor may also be secondary to any pain-related genital process, and can be activated by non-genital or non-sexual causes such as urinary incontinence or anorectal problems.
Therefore, amongst the causes of dispareunia, worthy of note are the following:
Introital and midvaginal
- Psychosexual
- Hormonal / dystrophic
- Inflammatory
- Muscular
- Traumatic
- Neurological
- Vascular
- Immunological
Deep Vaginal
- Endometriosis
- Pelvic inflammatory disease
- Pelvic varicocele
- Radiotherapy
- Referred pain
The diagnosis begins with a detailed medical history and physical examination. Depending on the data obtained, other studies may be indicated such as a hormonal and psychological evaluation.
Treatment of dispareunia must be focussed on resolving the factors identified in the diagnostic study, both psychological and physical.
In the presence of a persistent vaginal infection, the most suitable treatment should be pursued in accordance with the microorganism identified.
Muscular relaxation techniques should be taught and on occasion the application of certain analgesic methodologies.
Treatment for vaginismus is based on applying methodologies which reduce anxiety together with learning certain sexual behaviours in which both members of the couple should participate.