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

11 Responses to Dyspareunia: A Funny Word for Something Not so Funny

  1. Agreement on prunes- I’m eating some right now, and they’re lovely. A recipe would be great!

    I love this blog because I get medicine and food (two strong interests) in the same place…. thanks!

  2. Do you think that it is possible for dyspareunia to be psychological? I am 22 and developed deep dyspareunia two years ago. Five doctors and a laproscopy later and it is only getting worse. My last doc told me to see a phychologist.. but I am skeptical. Any insight? Thanks.

  3. Anonymous: I’m reluctant to give you any advice in this forum (ie., a blog). Although dyspareunia can occur if you are tense or not lubricated at intercourse, that’s usually the most “psychological” it gets. If you are not satisfied, seek additional opinions. I would suggest a reproductive endocrinologist or a pelvic pain expert.

    Good luck!

  4. What does a diagnosis of yeast involve? A swab, or a full exam, or what?

    I have been taking antibiotics for awhile and I’m pretty sure yeast is what I have, but I don’t want to go buy Diflucan and treat myself because I’m not positive.

  5. ANONYMOUS:

    Yeast infections are diagnosed by exam and by either looking at the vaginal secretions under the microscope or by culturing vaginal secretions. The former method has about a 50% false negative rate, at least according to a study my colleagues and I published not long ago. Culture is much more sensitive, but you need to be sure the lab is plating for yeast and results are not immediate.

    Self diagnosis is notoriously inaccurate, and I encourage my patients to come in and let me diagnose it if at all possible. However, if you have had yeast infections before, and your symptoms are typical for you, using an over the counter anti fungal is not unreasonable. If you’re not sure, see your doctor first.

    Good luck.

  6. Perhaps much of the pain women experience during intercourse is due to the circumcised state of their male partners.

    Kristen O'Hara explains why many women experience dyspareunia on her site: http://www.sexasnatureintendedit.com.

    For information on foreskin restoration, there is the National Organization of Restoring Men (www.norm.org) and Ron Low's site on his product, the TLC Tugger (www.tlctugger.com).

    There may, of course, be other causes for pain during intercourse, but this one seems to merit particular attention.

    Best wishes!

  7. Just came across your blog and it's fantastic! I love cooking and it never hurts to learn something new.

    Wondering if you have any websites to recommend on Endometriosis and up to date treatment options available?

  8. I used vaginal steams. They were awesome, increased circulation and I believe were instrumental in my fertility recovery. I used to have bad periods and a history of miscarriage. I used them as a part of my recovery routine. Not to mention, they feel good.

    Douching is only bad if you don’t know what you are doing and use over the counter store made crap. You can successfully use douche, sparingly for BV, yeast infections and dryness. Depending on the herbs used. Apple cider vinegar douche is crap. I have specific herbal recipes that are no-fail. IN fact, I don’t need to use them any more, or really really infrequently. I suggest not throwing the baby out with the bath water. Many of these things are “bad” because our culture is uneducated about their millenia of use. I suggest finding an herbalist who SPECIALIZES and is TRAINED in gyno care, and then opening up the mind. It is an amazing thing. I had this argument with a gyno friend of mine and she said what I was talking about was herbal application of herbs, she thinks of douche as the over the counter crap. Whatever, semantics. Liquid with stuff in it up your vajayjay. There is good stuff and bad stuff and what is good and bad depends on who you are and what you are treating.

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