Dyspareunia

Do you experience Painful Intercourse and/ or other Pelvic Pain that causes significant distress?

You have two options:

*See your GP for a check- up.
**Then depending on the outcome, ask your GP for a Referral Letter to Dr Miller for a more thorough review that could involve more comprehensive blood tests and ultrasound scans.

Possible Causes

• Insufficient lubrication
• Not enough foreplay
• Drop in oestrogen levels after menopause, after childbirth or during breast-feeding
• Certain medications inhibit desire or arousal such as antidepressants, high blood pressure
• medications, sedatives, antihistamines and certain birth control pills.
• Injury, trauma or irritation.
• Injury or irritation from an accident, pelvic surgery, female circumcision, episiotomy or a congenital
• abnormality.
• Inflammation, infection or skin disorder can cause a superficial pain at the beginning of the
• intercourse
• Vaginismus
• Involuntary spasms of the muscles of the vaginal wall which often can be a protective measure to
• avoid pain
• Deep pain
• Occurs with deep penetration and may be more pronounced with certain positions.
• Pathological causes
• Such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis,
• irritable bowel syndrome and ovarian cysts.
• Surgeries or medical treatments.
• Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes
• cause painful intercourse. In addition, medical treatments for cancer, such as radiation and
• chemotherapy, can cause changes that make sex painful.
• Emotional factors, sexual abuse and psychological problems.
• Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship
• problems can contribute to a low level of arousal and a resulting discomfort or pain.
• Stress
• Pelvic floor muscles tend to tighten in response to stress in life. This can contribute to pain.

Tests and diagnosis

A thorough Medical history, pelvic examination, vaginal swabs, pap smear and pelvic ultrasound +/- colposcopy will enable us to identify possible cause.

Treatments

Conservative

• Medications: Oestrogen cream, ordinary vegetable oil is the best lubricant (most other lubricants have alcohol/preservatives which may act as an irritant)
• Therapy: Desensitization therapy + counselling or sex therapy
• Drugs:Depending on the underlying problem antibiotics, oral endep, Amitriptilin 2% cream vaginally or some anti-epileptic drugs may be used.
• LASER: a non-invasive treatment for reshaping and revitalizing of scar tissue and atrophic mucosa of the vagina.
• Platelet Rich Plasma (PRP): a non-invasive treatment for reshaping and revitalizing of scar tissue and atrophic mucosa of the vagina.
• Combination of LASER and PRP.

Surgical

• Reversal of the scar
• Laparoscopy: excision of endometriosis, removal of ovarian cyst, adhesiolysis, removal of the fibroids, etc.

Some tips and home remedies

• Switch positions: changing positions may help. Being on top of your partner during intercourse may regulate penetration to a depth that feels good to you.
• Communicate: what feels good and what doesn’t? If you need your partner to go slow, say so.
• Don’t rush: longer foreplay stimulates your natural lubrication delaying penetration until you are aroused.
• Use lubricants: olive oil and vegetable oil are most effective, cheap and readily available (plus, they have the added benefit of being common household products)

Some common causes of Dyspeurunia are:

• Hormonal factors associated with Perimenopause and Menopause.
• Stress factors, including work or relationship issues.
• Previous traumatic birth or pelvic injury.
• Various infections including urinary tract and yeast/ fungal.

Some key Period problems are:

• Irregular cycles.
• Painful cramps for first days or even in a daze just prior to the start of the menstrual bleed.
• Pain in pelvic area restricting the use of tampons.
• Heavy bleeding with or without Anaemia.
• Excessive and / or prolonged bleeding, possibly involving many (large) clots.
• Migraines.
• Spotting in between periods.