|Classification according to ICD-10|
|ICD-10 online (WHO version 2019)|
A dyspareunia (from Greek dys- "miss-" or "bad" and " copulation " from pareunos "bedfellow"), also algopareunia (from Greek algos "pain" and pareunos , analogously "mating pain ") is one sexual dysfunction . It usually manifests itself in burning or cramp-like pain in the genital area during sexual intercourse , almost always without an orgasm when it occurs . The phenomenon occurs in both women and men, but the term as such is mainly used in connection with female vaginal sexual pain.
Until the middle of the twentieth century, the term was used exclusively for the indifference of women during sexual intercourse. Today, any form of physical or emotional mismatch between sexual partners is called dyspareunia.
The very varied organic causes can usually be remedied, but psychological complaints require long-term therapy. Often, after the main organic cause of dyspareunia has been remedied, psychological reasons ensure only a slow decrease in symptoms.
Causes and Therapy
Common causes of dyspareunia are acute or chronic urinary tract infections , which can usually be remedied with medication . Other possible causes (not all of them):
- Vaginal dryness
- Ovarian cyst
- Human papillomavirus
- Vestibular adenitis (Skenitis)
- Vulvar vestibulitis syndrome (VVS)
- Nutcracker Syndrome (pinched kidney vein)
Scars after childbirth are also quite common, e . B. after a perineal incision or perineal tear , which lead to pain when penetrating the penis , regardless of position . Scars in the vaginal area are also a possible cause. Depending on the location of the scar tissue, less painful or painless sex positions can often be found here. Furthermore, in ( endometriosis ) isolated cell aggregates in the pelvic area that resemble the uterine lining can lead to adhesions, inflammations and cysts. In hormone-dependent stimulation of these areas can cause pain. Endometriosis can be treated to a certain extent with hormone therapy . However, if the adhesions have progressed too far, only surgical intervention will often help.
Vaginal skin atrophy caused by hormonal disorders (lack of estrogen in old age) can often lead to pain during sexual intercourse. Without inflammation, the use of lubricants is recommended for the short term and hormone replacement therapy, e.g. B. with estrogen ointment (overnight). Systemic substitution with estrogen is viewed rather critically due to the long-term risks. In the USA, the FDA approved the selective estrogen receptor modulator ospemifene as an alternative to estrogen therapy in 2013 for the treatment of dyspareunia in postmenopause
This can lead to micro-injuries, especially in the area of the vaginal entrance , introitus vaginae , which then leads to painful sensory perception when mechanically irritated . In addition to these organic causes, dyspareunia can also be traced back to psychological causes. Due to stress , e.g. B. through negative sexual experiences in advance, unconscious tension and cramping of the abdominal muscles, skeletal muscles such as the muscle ( musculus ischiourethralis , musculus ischiocavernosus , musculus bulbospongiosus ) can occur during the sexual act . The pain that occurs in this process leads to sexual displeasure and this in turn, through partnership or general social pressure, to increased release of stress hormones during the next sexual contact . Discussions with the partner and with a psychotherapist can help in such cases.
Diagnosis in the DSM-5
Since the introduction of the DSM-5 in 2013, the diagnoses of dyspareunia and non-organic vaginism have been combined as the genito-pelvic pain penetration disorder . This decision resulted from the finding that the two disorders cannot be reliably distinguished. In contrast to the emphasis on vaginal muscle spasms in the DSM-IV diagnostic criteria for vaginismus, the focus of the new diagnosis is now on penetration problems, since empirical evidence of muscle spasm in vaginismus could not be provided. In addition, the fear of pain with vaginal penetration is characteristic of vaginismus, which also suggests a strong relationship between the diagnosis and dyspareunia. Affected women also frequently report impaired self-esteem as well as feelings of inferiority and worthlessness with regard to sexuality.
- Sexual headache
- Vulvar vestibulitis syndrome (VVS) in English
- Ospemifes in English
- ↑ FDA approves Osphena for postmenopausal women experiencing pain during sex February 2013
- ↑ Benefit assessment procedure for the active ingredient ospemifene g-ba.de, on October 20, 2016 p. 5, accessed on September 26, 2019
- ↑ Shionogi GmbH withdraws Senshio® from the German market January 2017
- ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) . 5th ed. American Psychiatric Publishing, Washington 2013, ISBN 978-0-89042-555-8 (English).
- ↑ a b Yitzchak M. Binik: The DSM diagnostic criteria for vaginismus . In: Archives of sexual behavior . tape 39 , no. 2 , 2010, p. 278-291 , doi : 10.1007 / s10508-009-9560-0 .
- ↑ J. van der Velde, E. Laan, W. Everaerd: Vaginismus , a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus . In: International urogynecology journal and pelvic floor dysfunction . tape 12 , no. 5 , 2001, p. 328-331 .
- ^ Joana Carvalho, Armando Luis Vieira, Pedro Nobre: Latent structures of female sexual functioning . In: Archives of sexual behavior . tape 41 , no. 4 , 2012, p. 907-917 , doi : 10.1007 / s10508-011-9865-7 .
- ↑ a b H. S. Kaplan: The classification of the female sexual dysfunctions . In: Journal of sex & marital therapy . tape 1 , no. 2 , 1974, p. 124-138 , doi : 10.1080 / 00926237408405280 .
- ↑ Barbro Wijma, Klaas Wijma: A cognitive behavioral treatment model of vaginismus . In: Scandinavian Journal of Behavior Therapy . tape 26 , no. 4 , 1997, p. 147-156 , doi : 10.1080 / 16506079708412484 .