Painful intercourse can be a difficult subject to broach: After all, sexual intercourse is supposed to be a pleasurable endeavor, this universal assumption leading the individual sufferer of dyspareunia to wonder if there is something wrong with her head, her vagina, or, Lord have mercy, both.

Truth be told, sex is not always a purely pleasurable thing for women at all times, and this can be a rare and normal occurrence in normal women. Dyspareunia is painful sexual intercourse, persistent or recurrent genital pain that occurs just before, during or after intercourse, resulting in personal distress.

But the other truth is that there are treatments that can reduce the pain of dyspareunia, and may even eliminate it.

Symptoms of dyspareunia in the 60% of women who suffer this include pain with even the penetration of inserting a tampon, superficial genital pain, deep genital pain-which can be burning or aching.

Of course, the causes of painful intercourse are varied:
1. Inadequate lubrication, which can be due to insufficient foreplay or estrogen levels, or as a side effect of certain medications.
2. Injury, trauma, or irritation.
3. Inflammation or other skin disorders.
4. Allergic reactions to birth control products.
5. Conditions such as uterine fibroids or endometriosis.
6. Infections.
7. Prior surgeries to the reproductive tract.
8. Psychological factors: Many women who have been raped or sexually abused as children suffer dyspareunia; the act of sexual intercourse can trigger memories of the trauma, and interfere with the pleasure of sexual intimacy. Guilt regarding the sex act, or fear of pregnancy, can result in dyspareunia. Relationship problems can commonly cause dyspareunia.

Treatment of the pain might be accomplished through:
1. Switching sexual positions. (For example, a woman on top of her partner can control the depth of the sexual thrusting, which can be painful for many.)
2. Communication. (A talk with one's partner can have the simple result of learning what causes pleasure and what causes pain.)
3. Longer foreplay allows for the stimulation of natural lubrication.
4. The use of lubricants.
5. Avoiding medications known to diminish lubrication.
6. Estrogen therapy.
7. Desensitization therapy, consisting of, among others, vaginal relaxation exercises which often reduce pain.
8. Counseling or sex therapy, which is particularly important for those dyspareunia sufferers who have dealt with pain for long periods of time. (Chronic dyspareunia can result in a negative emotional response to sexual stimulation, which often begs for improved communication, and can result in the restoration of sexual intimacy.) Counseling is particularly helpful in cases of abuse or rape.

Prognosis is good, although the counseling process might take time. In the meantime, physical love can still find its expression through sensual massage, mutual masturbation, and, yes, kissing.

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