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Wednesday, May 21, 2014

Painful Intercourse is Real and Treatable

Sexual pain disorders are extremely common.   Sexual pain in women is called dysparunia.   Dysparunia has 3 main causes: endocrine dysfunction, pelvic floor myofascial tension disorder, and neuroproliferative disorder.  Endocrine dysfunction is by far the most common, is easy to diagnose, and is easy to treat.  I'll be discussing that one here.

Males and females have the same reproductive hormones.  These hormones are testosterone, estradiol, FSH, LH, and SHBG.  In men and women, the health of various reproductive organs is vitally dependent on the proper interplay between systemic levels of these hormones, local intra-tissue levels of these hormones, and tissue receptor function to these hormones.  When this system breaks down, the tissue becomes unhealthy.  Women experience this as pain with sexual intercourse.

Most pain with sexual intercourse occurs at the introitus--the opening of the vagina where the penis enters. Sexual pain disorders affects young adults, middle age adults, and the elderly.  The number one culprit by far is the hormonal based contraception--the pill, the ring, the implant--it does not matter so long as the method is based on hormonal manipulation.  If your gynecologist disagrees with this, they are wrong.  It is that simple.  Too much quality basic science and clinical research exists to dispute it.

The only way your doctor would know if you have sexual pain is if 1: you tell him or 2: he/she asks.  It is then imperative that the doctor due a thorough inspection of the external and internal female genitalia with adequate light and optical magnification.  Then blood testing is indicated.  We test for the blood levels of the hormones and proteins mentioned above.

As for treatment, once the specific cause is identified, which is not difficult, treatment is easy as well, and can include a combination of topical testosterone therapy, locally applied estradiol therapy, combination estradiol/testosterone therapy applied locally to the genitalia, systemic progesterone therapy, and others.

In this day and age, thanks to the pioneering work of female sexual health clinicians and scientists across the world, women no longer need to suffer from sexual pain disorders.