24 سنوات
I am married before 2 weeks. but everytime we try to make the intercourse i feel anormal pain and cannot continue. what is the problem and how can it be solved?
10 سبتمبر 2014
The pain may be superficial, felt in the area around the opening of the vagina (genital area or vulva), or it can occur in deeper areas, within the pelvis, whereby it is felt upon deeper penetration of the vagina. The pain may be burning, sharp, or cramping. There may be associated tightening of the pelvic muscles, which aggravates the pain.
Dyspareunia, as is the case with any other type of pain, is under the influence of emotions. For example, minor discomfort may feel like severe pain after a traumatic sexual experience, such as rape. Anger toward a sex partner, fear of intimacy or pregnancy, a negative self-image, or a belief that the pain will never go away may make the pain feel worse.
Causes of dyspareunia differ according to the nature of the pain (superficial vs. deep).
Superficial pain:
Intercourse can be painful because the vagina tends to be dry (it does not secrete sufficient amounts of fluids). Inadequate lubrication often results from insufficient foreplay. Also, being on certain medications like antihistamines, or being dehydrated, can cause slight, temporary dryness of the vagina.
Superficial pain may also result from the following:
• Increased sensitivity of the genital area to pain (provoked vestibulodynia), which is the most common cause
• Inflammation or infection in the genital area (including genital herpes), the vagina, or Bartholin glands (the small glands on either side of the vaginal opening)
• Inflammation or infection of the urinary tract
• Injuries in the genital area
• Radiation therapy affecting the vagina, which can make the vagina less elastic and can cause scarring, making the area around the vagina smaller and shorter
• An allergic reaction to contraceptive foams or jellies or to latex condoms
• Involuntary contraction of the vaginal muscles (vaginismus): iIn vaginismus, vaginal muscles undergo involuntary contraction and tightening despite women's desire for sexual intercourse. Vaginismus usually begins when women first attempt to have sexual intercourse. It can however develop at later stages, for example, when another factor makes intercourse painful for the first time or when women attempt intercourse while they are emotionally distressed. Because intercourse may be a source of pain, women fear it. This fear makes further increases the degree of muscle tightening and causes or increases pain when sexual intercourse is attempted. A reflex reaction is thus generated, so that when the vagina is pressed or sometimes even just touched, the vaginal muscles automatically (reflexively) tighten. Consequently, women with vaginismus cannot tolerate sexual intercourse or any sexual activity that involves penetration. Some women cannot tolerate the insertion of a tampon or have never wanted to try. However, most women with vaginismus enjoy sexual activity that does not involve penetration.
• Rarely, a congenital abnormality (such as an abnormal partition within the vagina) or a hymen that interferes with entry of the penis
• Surgery that narrows the vagina (for example, to repair tissues torn during childbirth or to correct a pelvic floor disorder)
Deep pain:
Deep pain during or after sexual intercourse may result from the following:
• Infection of the cervix, uterus, or fallopian tubes (pelvic inflammatory disease), which may cause collections of pus (abscesses) to form in the pelvis
• Endometriosis (a condition during which the cells from the lining of the uterus (endometrium) appear and multiply outside the uterine cavity, most commonly on the membrane which lines the abdominal cavity, the peritoneum.)
• Growths in the pelvis (such as tumors and ovarian cysts)
• Bands of scar tissue (adhesions) between organs in the pelvis, which may form after an infection, surgery, or radiation therapy for cancer in a pelvic organ (such as the bladder, uterus, cervix, fallopian tubes, or ovaries)
Sometimes one of these disorders (such as fibroids) causes the uterus to assume a bent-backward direction (called retroversion, as opposed to the naturally bent forward uterus, or anteverted uterus), resulting in deep pain. Strong unintended (involuntary) contraction of the muscles in the pelvis (called pelvic muscle hypertonicity) can cause or result from deep pain.
The diagnosis is based on the history of symptoms, including when and where the pain is felt, and on the results of a physical examination. The genital area should be examined for possible causes, such as signs of inflammation or abnormalities. If any abnormality is noted, a sample may be obtained to be examined under a microscope (biopsy).
A doctor may touch the area gently with a cotton swab to locate the pain source. The doctor checks the tightness of the pelvic muscles around the vagina by inserting one or two gloved fingers into the vagina. To check the uterus and ovaries, the doctor then places the other hand on the lower abdomen. A rectal examination may also be done.
Couples are encouraged to find ways to attain mutual pleasure (including having orgasms and ejaculation) that do not involve penetration—for example, stimulation involving the mouth, hands, or a vibrator.
For superficial pain, anesthetic ointments (such as Emla cream) and sitz baths (iodine solution in warm water) may help; use of lubricant before intercourse is also useful. Water-based lubricants rather than petroleum jelly or other oil-based lubricants are recommended, because oil-based lubricants may dry the vagina and damage latex contraceptive devices. Spending more time in foreplay may increase vaginal lubrication.
For deep pain, using a different position for intercourse may help. For example, being on top can give women more control of penetration, or another position may limit how deeply the penis can be thrust.
More specific treatment depends on the cause, as in the following:
• Thinning and drying of the vagina after menopause: Estrogen inserted into the vagina as a cream (with a plastic applicator), as a tablet, or in a ring (similar to a diaphragm) or taken by mouth (as part of hormone therapy)
• Infections: Antibiotics, antifungal drugs, or other drugs as appropriate
• Cysts or abscesses: Surgical removal
• A rigid hymen or another congenital abnormality: Surgery to correct it
Some women may benefit from psychologic therapies, such as cognitive-behavioral therapy and mindfulness-based cognitive therapy. Mindfulness involves focusing on what is happening in the moment, without making judgments about or monitoring what is happening.
Pelvic muscle relaxation exercises are useful in the context of tight pelvic muscles as they teach affected women how to consciously relax them.
If it turns out to be a case of vaginismus, then treatment will focus on reducing the reflexive tightening of vaginal muscles and the fear of pain that take place when the vagina and surrounding area are touched. This is usually achieved by doing certain touching exercises.
1- Women touch an area as close to the vaginal opening as they can without causing pain. Each day, they should move a little closer to the opening, slowly increasing how close they can come to the vagina without causing pain. When they can touch the tissues around the opening (called labia), they can practice opening the labia. Women are encouraged to use a mirror to see their genitals. They are taught to bear down (as when having a bowel movement), which makes the vaginal opening larger, so that it can be seen more easily. Eventually, women can touch the vaginal opening without causing pain.
2- They are then instructed to insert their finger into the vagina, pushing or bearing down while inserting the finger to enlarge the opening and make insertion easier.
3- When they can do these exercises and experience no pain, they can start to use cone-shaped inserts, which are placed in the vagina. An insert is kept in for 10 to 15 minutes. Then the vaginal muscles become accustomed to pressure. As women grow less uncomfortable with an insert, they use progressively larger inserts, which gradually increase the pressure in the vagina. Ultimately, women ask their partner to place an insert in the vagina. Thus, women learn to relax the vaginal muscles and override the reflexive tightening.
4- Once the partner can insert the cone without causing pain, the couple's sexual activity can include touching the woman's genital area with the partner's penis, but without its entering the vagina.
5- After successful completion of these steps, the couple can try intercourse again. Doctors usually recommend that women hold their partner's penis and place it partly or completely in their vagina in the same way that they placed the insert. Some women are more comfortable being on top during intercourse at this point. This process may make some men be overly cautious and too reluctant to push, or they may lose their erection.
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