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Dyspareunia and sexual pain disorders

We talk about dyspareunia when there is persistent and continuous genital pain during or after sexual intercourse. What are the causes? how to intervene?

Sexual pain disorders. Sexuality is a fundamental and complex aspect of human nature, which accompanies the individual in his growth path.

Within this concept we can make a distinction between sexual acts, such as penetration, and sexual behaviors, such as being seductive. In addition to the variety of denotative meanings, we must highlight the richness of connotative meanings of the word sexuality. It is considered, especially for the female sphere, the area most charged with emotions, affections and feelings especially when analyzing the functions of the orgasm.

sexual pain disorders: the function of orgasm

The reproductive function of the male orgasm is readily apparent, given its association with semen ejaculation, as the experience of pleasure will act as a motivational source for further reproductive acts reinforced by it. On the contrary, in women this function is not so obvious, leading her to try to repeat the experience, beyond the gratifying and therefore reinforcing nature of the event. Scholar Bancroft notes that women seem to have a higher orgasmic potential than men, while at the same time a much greater proportion of them never experience one.

In addition to the purely physiological component of the female orgasm, it certainly plays an important role in modulating the emotions and feelings of the woman. A large number of researches in this area have found that most women assign purely emotional meanings to sexual intercourse and, consequently, to the orgasm itself. It no longer appears as a physiological experience but as a bearer of relational meaning. Taking into consideration the emotional-behavioral sphere, within the sexual substratum, is a fundamental prerequisite for understanding female sexual dysfunctions at three hundred and sixty degrees.

Sexual pain disorders: female sexual disorders

The assessment and diagnostic classification of female sexual disorders must take into account the various explanatory fields in which sexuality is reflected. From this point of view, in fact, the therapist, in taking charge of the patient, will have to consider the biological sphere, where chromosomal alterations can determine a serious symptomatic picture, the emotional sphere, which determines a hyper or hypo activity of the activation responses, the cognitive field and finally the behavioral field through the implementation of sexual relationships.

It is important to underline that the way in which the subject interprets his own thoughts, emotions and behaviors serves as the basis for an adaptive or maladaptive personality predisposition towards the other sex and the consequent relationships. These interpretations depend on the interpersonal patterns that have been created over time based on social relationships and the surrounding environment. Gender identity, self-image and the system of expectations are the privileged areas that can best reflect the individual-sexuality relationship and which, if altered, can favor the onset of sexual disorders such as, for example, Dyspareunia.

In this case it is necessary to ascertain how sexual interactions take place in the members of the couple as well as the sexual experiences of the individual, in order to better identify the symptomatological picture.

Dyspareunia: what is it?

Specifically we talk about dyspareunia when there is persistent and continuous genital pain during or after sexual intercourse. In women it should not be due exclusively to lack of lubrication but can manifest itself in many forms depending on the frequency and intensity of the pain. As previously written, sexual intercourse for women does not only have a carnal meaning but brings with it emotional and social aspects. At this juncture we can establish that this disorder has organic but also and above all psychological components. 

The incidence of dyspareunia is still little known but it would seem to have a wider diffusion than one might think. Statistical data, however, report that 10-15% of women experience pain during sexual intercourse in their lifetime and a higher percentage reports this symptom at least once in their life.

Biological, psychosexual and relational factors converge in the etiopathogenesis of this disorder, which can place dyspareunia along a continuum from primarily physical to purely psychological forms. The diagnosis of dyspareunia is appropriate in cases where the painful experience is persistent and severe and alters the sexual well-being of the woman and the couple . Once identified, it should always be clinically evaluated whether the disorder is of organic origin or is a sexual dysfunction, not excluding that this disorder can also be secondary to pre-existing organic problems.

From a therapeutic point of view, excluding the psychogenic cause, characterized by an intense and involuntary spasm of the muscles surrounding the vagina, the gynecologist’s task is to eliminate the organic factors that can determine the onset and maintenance of the disorder.

On the contrary, in the evaluation of psychological causes, a first aspect to consider is the comorbidity with any other dysfunctions . In fact, dyspareunia can be an expression of other sexual problems that can be associated with the absence of sexual desire and which, resulting in poor lubrication, can lead to the disorder. In many cases, the main manifestation of psychogenic dyspareunia is acute anxiety . This anxiety, associated with penetration during sexual intercourse, is converted into somatic symptoms, aimed at reducing or avoiding intercourse.

It is therefore of fundamental importance to consider the multiple meanings that underlie the concept of pain. The woman’s experience during and after sexual intercourse is characterized by a set of negative sensations that will compromise erotic availability. Given the complexity of the phenomenon and the psychological aspects that characterize it, it is essential to investigate the circumstances of the pain, the quality of the relationship and the satisfaction of the couple.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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