Dyspareunia

Dyspareunia can present in many different ways:

• Pain inserting a tampon
• Pain during the beginning of penetration (superficial dyspareunia)
• Pain during penile thrusting (Deep dyspareunia)
• Pelvic pain lasting hours or days after sex

Vulvodynia
The vulva is the medical term given for a woman’s external genitals. It is composed of several parts- labia majora, labia minora, clitoris and clitoral hood, urethral orifice (where urine comes out) and vestibule (entrance to the vagina). Pain experienced in the vulva can be constant or intermittent. It can occur only if the area affected is touched (provoked) or at any time (unprovoked). The symptoms experienced can vary in type and from day to day. Itch and pain are common symptoms.

There are many theories as to why a woman would develop genital pain. The most supported idea is that acute pain, as a result of infection, trauma or inflammation, becomes chronic. Nerve endings become hypersensitive, sending pain signals to the brain when there is no damage occurring. Pelvic floor muscles can go into spasm as a result of the pain, which can reduce blood flow to the vulva and make any inflammation worse.
Here is a list of some of the triggers:

• Infections (thrush, urinary tract infection)
• Trauma (sexual assault, birth complications)
• Systemic disease (Crohns)
• Gynaecological problems (endometriosis, pelvic inflammatory disease, uterine fibroids and ovarian cysts)
• Genital skin problems (psoriasis, dermatitis, Lichen Sclerosis)
• Use of irritants (soap, feminine hygiene products)
• Lack of lubrication
• Scarring from radiation treatment for cancer
• Female circumcision

An examination of your genital area is needed to look at the vulval skin and locate where the pain is being felt. I use the tip of a cotton swab to gently find where the problem is located. It is also helpful to see what your pelvic floor muscles are doing in response to the pain by using gentle insertion of a finger tip, only at your vaginal opening (introitus). I will not need to use a speculum and the examination is much more gentle than having a smear done. I understand that an examination might be daunting but rest assured that I will be very gentle. Your examination will be lead by you and what you are comfortable with (physically and emotionally).

Treatment depends on my findings on examination and whether some things have been tried already.

Here is a list of some of the possible treatments:

• Change of vulval hygiene practices
• Local anaesthetic gel
• Desensitization using self examination
• Pelvic floor physiotherapy
• Topical steroid creams
• Amitriptyline/gabapentin
• Behavioural techniques
• Relaxation techniques
• Talking about how it has affected your daily life, relationships and sex life

If you are unsure if I can help with a problem you are experiencing, please e-mail me at enquiries@spg.scot, which is an encrypted e-mail, to discuss further.