About dyspareunia or pain during sexual activities

Dyspareunia is frequent occuring pain in the genital organs that occur during sexual activity as responce to that activity. Dyspareunia can occure both in nen and women. This is not a single disease, but a group of conditions or problems that cause this kind of pain. The problem or cause can be situated by the partner that feels the pain or by the other partner.


Dyspareunia in men

In men painful intercourse can be caused mainly byfactors like:

- A short frenulum (thin membrane that connects the glans and foreskin)

- Phimosis (skin of the foreskin is not sufficiently flexible to permit the escape of the glans)

- Paraphimosis (foreskin retracted and locked in ring in conjunction auction glans penis)

- Peyronie's disease (or induratio penis plastica,

- Progressive fibrosis and thereby stiffening of the tunica albuginea, the membrane covering the corpus cavernosum of the penis),

- Curved penis recurvatum (abnormal curvature of the penis in the state of erection),

- inflammation of the glans, prepuce and urethra.

male dyspareunia may also be due to actors present in the partner.

- Resistant hymen or only partially opened hymen.

- Fibrous vulvovaginal dystrophy producing dry walls, inelastic vagina and reduced vaginal room.

- Vaginal infibulation (scars produced by previous female genital mutilation).


Dyspareunia in women

In women, the seat of pain can be traced to the outer area, the medial vaginal area or the deep area in and around the vagina. Dyspareunia in women should not be equated with vulvodynia, a condition which manifests itself even in the absence of sexual contact of torque.


- Autoimmun inflammatory disorders, like Sjögren's syndrome or other types of palvic inflammations.

- Allergic reactions in the vagina or vulva.

- A hymen that is not fully broken.


- Infections in the vaginal area due to yeasts and other infectants.

- Abnormalities in the pelvic area due to medical treatments (Iatrogenic disorders).

-Vascular disorders in the pelvic area.

- Psychogenic or relational conditions that result in cramps or other reactions in the pelvic zones.

- Sometimes the cause of vaginal pain during sex is a misproportion between the size of the vagina and the size of the mans penis.

- Sometimes the man goes forth too violently during sex.



About vulvodynia or chronic pain in the female genitals

Vulvodynia is chronic pain in the vulva or vagina without any anatomical findings or overt infections that can explain the pain. The pain feels like stinging and burning in the vulva and especially in the vaginal area. The pain be constant or flair upp intermittantly.

The pain can occure by itself or occure by touch form an obkect, as by sexual activities or by insertion of an object.

The pain can be of such a degree that it is difficult to sit, riding a bike, inserting a tamppon or have sexual activities. Depending upon the character an and location of the pain, special terms are used about the condition.

The condition can start in the puberty or from the time a women gets sexually active.

- Vulvar vestibulitis or vestibulodynia is pain condition in the vestibular region, the area between the small lips that are the entry point to the vagina.

- Dyspareunia is called pain occuring by sexual intercourse. Also men can have such pain.

- Chlitorodynia is pain conditions in the clitoris.


Physical causes of vulvodynia

The hypotheses about the reason for urodynia are numerous and probably different cases have different causes.

- There may be an allergic reaction to microbes or substances normally found in the vaginal area, for example oxalate.

- Yeast infection, bacterial vaginosis, HPV or other infections can be a cause. Yeasts are normally found in this area, but when the yeast are more abundant or more invasive, it can be called an infection. Other tpes of infection may be hidden and not cause visible symptoms.

- There may be an autoimmune disorder and vulvodynia may be the symptom of such a diorder in the genitals, such as Lupus erytematosus, a chronic rheumatic disorder affecting many parts of the body.

- Some women may have an abnormal number of nerve endings in the vulvar area that can recogize painful stimuli.

- Vulvodynia may be fibromyalgia where the vulva is the only place or one of the places where the symptoms are felt.


Psychological or psychosomatic causes of vulvodynia There has been a tendency to characterize vulvodynia as basically a mental diorder. The disease have been viewed as related to depression or anxiety. This view have been heavily chriticized. Still this explanation may be true in some cases or be a part of the cause. Signals from the vulvar area may be processed in an altered way when they reach the brain and they may therefore be interpreted in a negative way and felt like pain. Chronic spasms in the muscles of the vulvar area might be a causal factor and such spasms may further be related to psychological processes.. Spasms that appear when it is time for penetration by the man's penis can also be a cause of vulvodynia or a complication of vulvodynia - so-called vaginismus.


Diagnosis of vulvodynia

The diagnosis is based on the fact that the patient is perceiving pain without there being found physical causes that can explain the pain, and there is absence of identifiable causes for differential diagnosis.

On eoften uses a "cotton ball test" to delineate the areas of pain and categorize the severity. Patients often describe the feel of cotton ball as extremely painful, like the friction of a knife.

Many patients visit several doctors before a correct diagnosis is made. Many gynecologists are not familiar with the condition, but the awareness is spreading over time. Furthermore, patients are often reluctant to seek treatment for chronic vulvar pain, especially since many women begin to feel symptoms when they become sexually active.

Moreover, the absence of visible symptoms means that, before being diagnosed, many patients are told that the pain is of psychogenic origin ( "in their head"), and hence are not real. Even if this explanation might be true in some cases, the pain is still real and should be taken care of.


Treatment of vulvodynia

There are no standard treatment for vulvodynia, and different women respond well to different treatments. Many of the treatment modalities are based on the asume that the condition originates from exaggerated signals from these nerve endings around the vaginal opening or just inside the vaginal opening due to processes in the tissues at that place, or due to oversensible nerve endings.

Other treatments are based on the idea that the conditions are wholly or partially caused by mental problems or by muscular tentions that are connected to psychological problems.

Current moods of treatment are:

-Avoiding everything that can irritate the vulva, such as soaps. Using only water for genital wash. Using cotton underwear. Using menstrual pads of cotton.

- Rinsing and drying the vulva gently after urination with pure water and cotton.

- Sitting on soft pads during work and rest can be of help.

- Having a low-oxalate diet, often combined with calcium citrate supplement. The oxalate level can be measured with urine specimens.

- Finding other ways of sexual stimulation than those causing pain. Often penetration must be avoided. Oral sex or mutual masturbation can be ways to get sexual pleasure without the danger of getting strong pain.

- Techiques that gives the women better ability to relaxe and tense the pelvic muscles at the right times can help. Some therapist use biofeedback techiques to learn the women good relaxation and tension. Daily meditaion may also be useful.

- Gradual stretching of the vaginal area can be useful. Some therapist perform special techiques to effect such stretching. Such stretching can also be self-adminitered by means of dildos or the like with the right sizes.

- Strengthening the pelvic muscles and the muscles around the vagina may help. Also strengthening other msucles in the lover body may be of help. Kegel exercizes can be a means to do so.

- Antidepressiva or anti-anxiety has proven to help some women.

- Topical creams containing oestrogen or testosterone has shown to help some women.

- Injection of local anaesthetic can be of help.

- Surgery where one removes skin around the vaginal opening and stretches skin from nearby areas to recover the area ,or surgery to cut nerves in the vulvar region may help in severe cases. Such surgery will however only succeed in 70% of cases.



Meditation as a means to increase and make room for the good sexual feelings

Many, perhaps most, persons are full of worries for the near and distant future. Most persons also struggle through each day in a long day's work and in keeping their private homes and family life in shape. All these struggles, stresses and worries make the mind constantly spinning and constantly proccupied, so that there is little room left for concentration upon activities that bring joy and pleasure, and when engaged in such activities, the brain is so full of other processes that it do not have any capacity left for feeling the good things. The sexual pleasure is perhaps the one thing that suffers most from all this useless and exhausing mental processing.

Most persons therefore need to do something to stop the constant and exhausting mental work about evryday matters regarding professional life and family so that the mind can use its capacity for good sexual feelings and other good sensations

Also many persons have learnt from their childhood that sex is something sinful and that sexual feelings are something one should not have. Therefore many persons suppress all mental activities that result in good sexual feelings.

Some daily meditation is a method that can make you able to set aside the worries and struggles of the daily life, so that your mind gets room for the good sexual feelings and other good feelings.

Meditation can also help to make you conscious about psychological defence mechanisms and psychological deadlocks and then you get the ability to loose up these locking mechanisms in your mind that are barring for your good sexual feelings.

When doing meditation you sit still in a quiet place. Then you lay aside all everydey worries much as you are able to do so. Then you let your mind concentrate calmly upon some thought, some inner picture or some word that you repeat. This calm concentration makes the worries go even further away and possibley totally cease.

In this calm state of mind your body will also relax. Daily meditation will make you able to relax and set aside worries also when you are not meditating. Then your mind will have more room for all good feelings, included the sexual feelings and even room for real sexual ecstacies.

Meditation also allow your consciousness to go deper into your mental processes and be aware of mental mechanisms that are barring good sexual feelings. Then you get the power to loose up those mental locks.


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Requirements to achieve maximal pleasure in the intimate body zones

Here are listed some requirements to get as most pleasure as possible in your intimate body zones during the sexual act.

A good engorgement in the genitals when they are stimulated, is very important for the pleasure you feel during sexual activities. In men a good engorgement result in a strong and stable erection. In women the engorgement is seen and felt as an ample swelling of the clitoris and the female lips. Both by men and women the engorgement is the result of blood filling up in erectile bodies, networks og very elstic blood vessels, smooth muscle cells and elastic connective tissues

The engorgement stimulate sensual bodies in the genitals. These bodies are nerve ends surrounded by connective tissue sheets. Pressure fom the outside is concentrated by these connective tissue sheet towards the nerve ends and when this impact onto the nerve ends gets strong enough, a sensorial impulse is fired through that nerve towards the brain. Some of this stimuleting pressure comes from the engorgement of the erectile bodies. When engorged erectile bodies allready have increased the pressure towards the sensual bodies, just a little more pressure form caresses or movements towards the genital area will make the pressure surpass the treshold necessary to fire sensual impulses through the nerve cells towards the central nervous system.

When sensorial impulses are sent to the spinal column and the brainm, impulses are also sent back to the genitals that boost the engorgement and other physical reactions in the genitals even more.

The sexual organs excrete fluids that lubricate during sexual actions, and a good lubrication is necessary to avoid pain and maximize the intimate pleasure. The secretion of lubricating fluids is especially distinct in the vagina of a women, but also men excrete such fluids that come out through the urethral opening. The penis head and the area between the intimate lips of a woman also excrete a lubricating substance called smegma.

During the sexual act, there shall be rhythmical reflexive movements in the body muscles, and especially in the muscles of the pelvic organs. These contractions are controlled both by authomatic nervous reflexes and by conscious controle. These rhythmical movements and contractions of course have a maximum during the orgasm and ejaculation, but shall nevertheless be there the whole time. These rhytmical contractions greatly stimulate the sensual bodies in the intimate zones. If these contractions lack or are hindered through constant tension, the pleasure during the sexual activities will be decreased.

Both men and women excrete substances that give an arousing scent, so called pheromones. The degree of pleasure you get from the sexual act also depend upon an unhinderd secretion of these scents and upon the right chemical composition in the pheromones.

The engorgement, the production of lubricants and the pheromone production are heavily dependent upon the quality of the blood circulation to, in and from the genital organs, that is blood vessels that can relaxe and contract dynamically when needed and that are not clogged by patological processes. A good blood circulation is therefore useful for the intimate pleasure.

A good engorgement, good secretions and other physical reactions are also dependent on a nerveous system that works properly. The ability to sense pleasure is also dependent of a well working nervous system

These processes and the muscular contractions are also very dependent upon a nervous system that works proberly. If you are stressed or troubled in some way before and by the sexual act, your nervous reflexes will be badly influenced. It is therefore a good idea to stress down and try to lay aside troubles before you have sex.

Psychological stimulation before and during the sexual act is often underestimated, especially by men. A romantic and pleasant atmospaere and a sensual foreplay will make both men and women psychologically aroused. Then signals will go down to the intimate area that induce engorgement, excreteion of lubricating fluids and excretions of pheromones.



These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. This information is nutritional in nature and should not be construed as medical advice. This notice is required by the Federal Food, Drug and Cosmetic Act.