Dyspareunia: A Funny Word for Something Not so Funny

“Dyspareunia” is the medical term for painful intercourse.

I always liked the word, although it does sound a little whacky. Today I saw a patient who has dyspareunia, and decided to once and for all figure out the origin of the word. Turns out it derives from the Greek word “dyspareunos”, which means “badly mated”. To go even further into the Greek origins, “par” or “para” means beside or side by side, and “eun” means bed, so “pareunia” means to be side by side in bed, and is the ancient Greek term for sexual intercourse. Adding the prefix “dys-” means that what’s going on in bed is not so good.

Of course, outside of medicine, we no longer use the Greek terms, because it leads to too much confusion. “Hey, honey, do you wanna’ pareun?” makes it sound like you are offering up a serving of dried fruit. (Well, depending upon how old you are, maybe you are…) But if you like prunes as much as I do, either a pareun or a prune will do nicely, thank you very much.

Since I brought it up, let’s talk about what causes dyspareunia and how we treat it. In decreasing order of frequency of occurance in my practice, the causes of dyspareunia are:

Menopausal dryness
That’s easy to treat. Lubricants, vaginal estrogens, and keep having sex. The old adage “Use it or lose it” really does apply here. Sexual activity (even masturbation) increases blood flow to the vaginal tissues, helping lubrication. So, let’s go ladies, you’ve got some work to do…

Yeast infections.
Most women don’t know that vaginal dryness can be a symptom of a yeast infection. Well, it can be, and in my experience, is frequently the only symptom. When it is the only symptom, I often find yeast called Candida Glabrata, a strain resistant to standard over-the-counter remedies. But whatever strain of yeast you have, I can easily treat it, and that should solve the problem of dyspareunia.

Desquamative vaginitis
An inflammatory condition of the vagina that we treat with steroids and antibiotics. If you have dyspareunia, make sure your doctor looks at your vaginal secretions under the microscope right there in the office, otherwise this condition will be missed. Desquamative vaginitis can be chronic in nature. It is similar to, but not as bad as lichen planus (described below.)

Post partum dryness
Due to low estrogen levels while breastfeeding. Treat it with vaginal estrogens. Use a good lubricant. And have sex, if you can manage to stay awake for more than 2 seconds after hitting the sack.

Vestibulitis/Vulvadynia
These are non-infectious conditions that cause vulvar pain, sometimes with inflammation of the entrance to the vagina. Technically, vestibulitis and vulvadynia are separate entities, but since there is a lot of overlap, we often treat them the same. Vestibulitis may be associated with genetic variations in the proteins that mediate inflammation. Both vestibulitis and vulvadynia can be difficult to treat. We use low dose antidepressants, topical anesthetics, anti-inflammatory meds, interferon injections and, as a last resort, resection of the involved tissues. Changes in diet can be helpful in some patients. There are lots of other things you can do yourself to help the symptoms, see the resource list below.

Lichen planus
An uncommon chronic inflammatory condition of the mucous membranes of the vagina and mouth. We treat Lichen Planus with steroids and antibiotics, although it can be very difficult to treat. A new drug called tacrolimus shows promise in patients who don’t respond to typical treatment. If your partner has Lichen Planus of the vagina, be very, very nice to her because it is no fun to have lichen planus.

Something structural
A cyst, an abscess, a stricture, a hymeneal remnant, a vaginal septum, endometriosis, a fibroid – anything that’s getting bumped or pulled can hurt. Fix it, remove it, treat it, whatever, the pain goes away. Endometriosis treatment can be a little more complicated than some of the others, but it’s rare that we can’t control the symptoms enough to keep sex pleasurable.

Vaginismus
Another fancy word, this one means an involuntary contraction of the vaginal muscles and vaginal opening. You can’t get in if the door is closed, so don’t try to force it, because it only hurts more. Make sure there’s nothing else wrong (see above). Then use biofeedback, relaxation, masturbation techniques, couple’s therapy, topical anesthetics, and sometimes dilators. Botox is being used for this condition with some success.

Whether or not you have dyspareunia, you should eat some prunes. They are very good for you. Now that I’m thinking about it, maybe I will post a prune recipe, would you like that?

Dyspareunia: Resource List
National Vulvadynia Association
AAFP Article on Vulvadynia
Vulvar Pain Foundation
University of Michigan Center for Vulvar Diseases
Diagnosis and Treatment of Atrophic Vaginitis
Yeast Infection Resource Center
Pamphlet on Dyspareunia

Photo: “Plums in a Tree”, used with permission from stockphoto.com. Category: Second Opionions, Food