Pain in the vaginal canal is usually associated with an underlying medical and/or psychological condition.
Vaginal pain is experienced usually during vaginal manipulation or sexual intercourse. Approximately 50–85% of the causes are due to organic (medical) conditions. However, it is typical for the medical condition to be compounded by psychological issues such as depression and problems associated with sexual identity. The primary entity concerns dyspareunia, a vaginal pain experienced during sexual intercourse. The vagina has three physiological functions: an outflow duct for menstrual discharge, to receive the penis during sexual intercourse, and as the birthing canal. The overall prevalence for dyspareunia is 20% (15% of women and 57% of men). A significant percentage of breast cancer and hysterectomy patients demonstrated sexual dysfunction.
Causes and symptoms
The causes can be categorized as organic, due to a medical condition and/or psychological difficulties. Medical conditions can include chronic diseases, minor ailments, breast cancer, and medications. Psychological cause can be related to physical or sexual abuse. Pregnancy and hormonal changes (decreased estrogen) have significant negative impact on sexual activity, desire, and satisfaction. Dyspareunia can be divided into three types of pain: superficial, vaginal, and deep. Superficial pain is associated with attempted penetration. This is usually caused by changes in anatomy, irritative condition, or vaginismus. Vaginal pain is associated with friction, indicating a problem with lubrication and /or arousal disorders. Deep pain is related to thrusting and is indicative of pelvic disease or an inability for pelvic relaxation.
The diagnosis must be pursued with diligence and in a comprehensive manner. A careful history and physical examination is essential. Procedures that can be used include surgical investigation (laparoscopy) and treatment of the underlying cause(s).
Laith Farid Gulli M.D., Kathleen Berrisford MSW, CSW, The Gale Group Inc., Gale, Detroit,