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Painful Intercourse (Dyspareunia)

From the GYN Diagnosis Articles List

Hysterectomy for DyspareuniaMy doctor has suggested a hysterectomy because intercourse is painful for me. Is a hysterectomy really the solution? Will it stop my pain?

Painful intercourse, or dyspareunia, can occur for a number of reasons. Whether or not a hysterectomy will alleviate your issues will depend on the reason(s) for your symptoms.

Pain during intercourse that occurs with entry may be related to a number of issues. These can include a lack of adequate lubrication, vaginismus, inflammation, infection of the genital area or urinary tract, skin disorders, an injury, or prior trauma. As the uterus does not cause or affect any of these issues, a hysterectomy is not a likely solution for any of these concerns.

If pain occurs with deep intercourse, the issue could be the result of a wide variety of gynecological conditions. These can include endometriosis, fibroids, pelvic organ prolapse, a retroverted uterus, pelvic inflammatory disease (PID), or ovarian cysts. In some cases, a hysterectomy could alleviate these sources of pain. For instance, removing the uterus would eliminate uterine prolapse and retroverted uterus concerns. On the other hand, a hysterectomy does not cure endometriosis, and PID can occur post hysterectomy. For these conditions, it depends on the extensiveness of the disease as to whether or not a hysterectomy would be a possible solution. Depending on the location and type of fibroids, there can be treatment options besides a hysterectomy you can consider. Removing the uterus would not address issues involving ovarian cysts.

Hormonal imbalance issues can also cause painful intercourse. If the issue is a result of vaginal dryness and thinning tissues caused by no or low estrogen, a more appropriate course of treatment would involve some type of estrogen therapy. A hysterectomy could actually worsen any hormone-related issues.

There are non-gynecological reasons for painful intercourse as well. These can include irritable bowel syndrome (IBS), interstitial cystitis (IC), adhesions, and physiological concerns. None of these issues can be resolved with a hysterectomy. Instead, each condition would need to be treated individually. Counseling could also be beneficial.

Because there are so many reasons for painful intercourse, it is wise to keep a detailed symptom diary that you and your medical team can review. This will help you determine the cause of the pain and the best course of treatment. The HysterSisters also recommend you seek a second opinion, preferably from a doctor who does not practice obstetrics. Both a gynecologist who specializes in pelvic pain or a uro-gynecologist could be good choices. Additionally, finding a doctor who has a special interest in sexual dysfunction could help with proper diagnosis and treatment.

A hysterectomy should be a last resort option for dyspareunia, especially if there is no diagnosed reason for the pain. Most reasons for painful intercourse are unrelated to the uterus, and thus a hysterectomy may be of little help. If the cause of the pain is determined to be uterine related, then a hysterectomy could be considered as an option after other less invasive options have been tried.

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

06-06-2013 - 10:43 PM


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