Painful Sex (Dyspareunia)

Painful sex, known as dyspareunia, can arise from various factors, encompassing both physical and psychological aspects. This condition, characterized by persistent or recurrent genital pain before, during, or after intercourse, affects a significant number of individuals globally (World Health Organization, 2006).¹

Symptoms

If you’re experiencing dyspareunia, you may encounter:

• Pain solely at sexual entry (penetration)
• Pain with every penetration, including tampon insertion
• Throbbing pain persisting for hours after intercourse

Causes of Painful Sex

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1. Superficial:
   • Lesions in the lower part of the labia minora or around the fourchette
   • Narrow introitus, tough hymen, Bartholin gland cyst, tender perineal scar, vulval infection, urethral pathology
2. Vaginal:
   • Vaginitis, vaginal septum, tender scar, tumor, vaginal atrophy, vaginal atresia
3. Deep:
   • Endometritis, chronic cervicitis, cystitis, chronic pelvic inflammatory disease (PID), retroverted uterus, prolapsed ovary in the pouch of Douglas

Emotional and Psychological Factors

• Emotions intertwined with sexual activity may contribute to Painful Sex
• Anxiety, depression, concerns about physical appearance, fear of intimacy, or relationship problems can impact arousal levels, resulting in discomfort or pain
• Stress can lead to pelvic floor muscle tightening, contributing to pain during intercourse

Diagnosis

• Thorough questioning by the doctor regarding the site and type of pain
• Per speculum examination, internal digital examinations (per vaginal and per rectal), and pelvic ultrasound may be recommended

Treatments

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• Ensure your bladder is empty before intercourse
• Take a warm bath after sex
• Treat infective lesions of the vulva, cervix, or vagina
• Excise tender scars in the perineal area of the vagina
• Sex education for both partners can often alleviate symptoms
• Non-medication therapies like desensitization therapy, counseling or sex therapy, and cognitive-behavioral therapy can be effective

Ayurvedic Treatments of Painful Sex

• In Ayurveda, painful sex is termed Maitunaasahishnutha
• Pain is often due to Vata imbalance, and therapies addressing Vata imbalance are effective³
• Infections causing Pitta imbalance can be treated with vaginal washes using anti-inflammatory drugs like Thriphala and Neem with turmeric
• Sitz baths in warm water help balance Vata and relax pelvic muscles
• Oil enemas with Bala tail, Maha narayana tail, or sesame oil are effective
• Tampons dipped in oil can be used for lubrication but are contraindicated in the presence of vaginal infections
• Butterfly pose (salabhasana), Kegel exercises, and specific Ayurvedic formulations like Kumarayasava and Gandharva hasthadi kashayam can be beneficial

References:

1. www.ncbi.nlm.nih.gov 
2. D.C. Duttas Text book of Gynecology. 6th Edition chapter 33 page no 568 .
3. Charaa samhita chikitsasthana edited by Yadviji Trikamji Chaukamba Surbharati Prakash Varanasi 3rd edition chapter 30 verse 61