Talk:Dyspareunia

Circumcision as cause of pain for some men and women
I've edited this article to add circumcision as a cause of pain for some people, and have provided a source from a medical journal. The edit was reverted for "not being constructive", whatever that means; I edited it to read "for some women", since the original header has to do with common causes and not all women seem to be affected (that they're aware of anyway), and the collection of evidence of harm is relatively new.

In any case, hopefully the new edit will be left alone, and just wanted to mention it here because it's not something that should be omitted from this article. — Preceding unsigned comment added by 47.55.192.86 (talk) 19:55, 2 March 2016 (UTC)
 * We tend to stick with review articles for medical content per WP:MEDRS. Therefore removed. This ref is better  Doc James  (talk · contribs · email) 04:23, 3 March 2016 (UTC)

Peer Review
Hi Sarah! Great job editing this article. It is incredibly more readable than the original version. It's a long, detailed article, so I'll just give a couple comments that I noticed while reading it. You did a great job changing the language and linking to other articles, but I think there might be a bit of room for word simplification in a few places that might make it more accessible to non-medical folks. For example, "self-perpetuating" and "acquired" in the first paragraph of the lead. You might also consider linking the word "vagina" and "vulva" in the Signs and Symptoms section to its separate Wiki article. My second comment is about the Causes section. This is my favorite change that you made- the reorganization gives you a chance to explain a bit more in depth than the original article, and I think this is probably a highly read section! My one comment would be to consider simplifying the title of each numerical subject that you've included. For example #1 = Infection, which is nice and straight-forward, but #2 has a phrase describing the topic and then another long sentence describing further. I think it may be a bit more readable all topics were 1-3 words (i.e #2 = "Injury after Trauma") after which you could continue your description. Just some thoughts! Overall, this is a really great article, and I love that you included the History section at the end. Good job!

Treatment edits
I have a relationship to this research. I am aware of Wikipedia's policies and guidelines and will abide by them. I am volunteering information for this talk page, and ask for Wikipedians’ help in determining if these edits are suitable for the page. Please consider adding to the treament section.

A manual physical therapy (Wurn Technique) which treats pelvic and vaginal adhesions and microadhesions may decrease or eliminate intercourse pain. In a controlled study, Increasing orgasm and decreasing intercourse pain by a manual physical therapy technique, twenty-three (23) women reporting painful intercourse and/or sexual dysfunction received a 20-hour program of manipulative physical therapy. The results were compared using the validated Female Sexual Function Index, with post-test vs. pretest scores. Results of therapy showed improvements in all six recognized domains of sexual dysfunction. The results were significant (P </= .003) on all measures, with individual measures and P-values as follows: desire (P < .001), arousal (P = .0033), lubrication (P < .001), orgasm (P < .001), satisfaction (P < .001), and pain (P < .001). A second study to improve sexual function in patients with endometriosis showed similar statistical results.

Personal Experience
This information comes from my own personal experience, and I hope this is enough information to help steer someone else who may have the same problem in the right direction. I'm unable to give references; however, I noticed the cause of my problem was not listed in the article. I was diagnosed with a fungal infection in my bladder that was resistant to treatment. I do not know the name of the fungus I was infected with. What I do know is that the treatment to clear up the infection required a 5 night hospital stay during which I underwent constant bladder irrigation with the medication amphotericin B. It took about five months from when the pain started for my medical team to figure out what the problem was and while intercourse was not the only time I experienced pain, it was what lead me to the right path of doctors to find the problem. My gynecologist noted that, when she pressed toward my bladder, it brought me to tears. This prompted her to send me to a urologist who was able to diagnose me. This is not a common infection, but according to my urologist, it is becoming more common and is more prevalent when you're a diabetic who has needed either strong or frequent antibiotics. If you have painful intercourse and have not been able to locate another cause, it may be worth having your doctor check for fungal infections in your bladder. One additional note, I hadn't realized that my urine being cloudy was a sign of a fungal infection, and kept having my family doctor check for a bacterial infection. If you do have a fungal infection, the cloudiness will not come and go, but will remain constant. —Preceding unsigned comment added by 333wikiuser (talk • contribs) 06:31, 23 March 2010 (UTC)

Dyspareunia – Physical causes in men - Frenum of the foreskin

 * 1) The statement “During vigorous intercourse or masturbation, small tears may occour in the frenum of the foreskin and can be very painful” in the Article needs some expansion, especially the first part, because it hints at blame on the part of the man or the woman or both.  See Jonathan Cope’s article for The Guardian: “Ouch!” (http://www.guardian.co.uk/lifeandstyle/2002/feb/28/healthandwellbeing.health2 ) ‘... the ... advisor’s suggestion that we were to blame for having too much sex was unhelpful, upsetting and, as I was to find, nothing to do with the problem’.  Further analysis is therefore required to reach the problem.
 * 2) Where the frenulum is short and slender, it is put under extraordinary relative tension during intercourse, on penetration.  Thrusting is consequently difficult and with even the greatest care, it is discomforting and awkward for the man, and bruising or rupture of the frenulum is almost inevitable.  This is different from masturbation where the man does not share the controls with a partner and is therefore himself able fully to control/manage the pain and risk of bruising or rupture.
 * 3) Around one in twenty men have the condition (Source: Ouch!  5%). The frenulum is hidden inside the protective cover provided by the foreskin and is also further hidden, i.e. being on the underside of the penis glans.  During intercourse, any apparent vigorousness in men with the condition is attributable to their attempts to avoid pain (tears and/or bruising) by their adopting or attempting combinations of long, but slow and tentative, strokes and very short strokes which naturally tend to need to be rapid and numerous to achieve sufficient stimulation, lengthways, for climax.  Then the risk of tears or bruising is at its greatest.   Such tears naturally increase infection risk, can bleed, and leave scar tissue.
 * 4) The condition is called frenulum breve and is remediable under local anaesthetic by a surgical procedure called frenuloplasty.  This may be carried out either before (i.e. as a preventative measure) or after tears occour.  The procedure keeps the foreskin intact, 'has a low complication rate and, with good preoperative counselling, has excellent patient satisfaction'. (Dockray, J., Finlayson, A. and Muir, G. H. (2011), Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring. BJU International. doi: 10.1111/j.1464-410X.2011.10678.x).
 * 5) Given that there has been little in the way of modern published medical research and information on the subject, and that there is still much general ignorance about it: it remains difficult for men affected by the condition to find a way into the subject; to talk about it; or to know even that it is a ‘condition’; that it has a name; and that it can be remedied.    Hence this contribution on the Talk page here.  Abstinence, sometimes requiring unnatural degrees of self-control, is one way of avoiding the pain and difficulty.  Certain consequent social interactions and situations and medical advice interactions can prove challenging though, and result in excessive inner mental /logical conflict, causing anxiety and distress.  If left unresolved this can quickly become chronic and lead to a severe mental health problem which can only start to be resolved once the condition is understood and, ultimately, addressed. (See also: Professor F Grewel  - The Frenum Praeputii and Defloration of the Human Male – Folia Psychiatrica, Neurologica at Neurochirurgica Neerlandica 61(2) p123-126 1958 http://www.male-initiation.net/library/medicus/grewel.html#start  ).
 * 6) The thought, or prospect, of any surgery in that area of the body, and given risks with any form of surgical intervention, is itself known to be distressing (whether adult or infant) and anxiety-inducing for the human male.  The conservative frenuloplasty method  (as described by Dockray, Finlayson and Muir and published in December 2011), with its good outcome statistics, and when combined with good pre-operative counselling, is therefore a significant step forward in understanding the condition and treating it suitably.


 * This is my first contribution to Wikipedia. I hope it sufficiently respects all the various protocols and so on. Please accept my apologies if falls short on those at all, but I believe it is important that the analysis above is aired and shared, and open of course to other inputs and clarifications that may arise.

MowbrayL (talk) 11:50, 1 April 2012 (UTC)

Re: Wikimedicine Peer Review Feedback
Thanks so much for the feedback- very appreciate the specific details of language to simplify and honing in on the section of causes as particularly useful to continue to simplify!

Long Penis
I noticed that nowhere in this article, nor Mayo Clinic or Cleveland Clinic articles, does it mention that pain can happen because of of a long penis that hits the cervix. Does pain involving the penis hitting the cervix always mean there is an issue with the cervix or uterus? RyanDanielst (talk) 18:32, 18 December 2019 (UTC)
 * The situation you describe, RyanDanielst would not be considered to be an instance of dyspareunia.--Quisqualis (talk) 19:26, 18 December 2019 (UTC)
 * The opening paragraph has "The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix." So if it's just pressure on the cervix, then a large penis would be a cause, would it not? Just wondering. RyanDanielst (talk) 02:08, 20 December 2019 (UTC)

These journals might be predatory, but it lists a large penis comparable to a smaller vagina as a reason for dyspareunia. He diagnosis as RSVS (relative short vagina syndrome). Should I list it as a cause and cite these journals?

Journals: Presentation of 03 Case Reports that Help Gynecologists Understand the Deep Dyspareunia

Measurement of Vaginal Flexibility and its Involvement in the SexualHealth of Women RyanDanielst (talk) 01:26, 5 January 2020 (UTC)

I added a cause of a longer penis or shorter vagina, but I am removing it. There is some controversy regarding it. The first citation may be a predatory journal. The second citation is legitimate, but mentions a long penis as a cause of deep dyspareunia. It does not mention cervicitis as a cause - which if they have cervicitis, then a "long penis" would be an issue. Cleveland Clinic and Patient (UK) both mention that the cervix should not hurt with pressure from the penis, so a penis knocking it would not be a problem. The source does mention a retroverted uterus as a cause, but also mentions a long penis, so not sure. I am going to leave the cited sources here and ask that someone with expertise shed some light on this issue. Would a long penis knocking the cervix be a source of dyspareunia, or not. 47.28.71.69 (talk) 22:56, 6 January 2020 (UTC)


 * RyanDanielst, I found both primary research and clinical practice recommendations on dyspareunia. The link between deep pelvic pain and penile thrusting is only made in instances of a retroverted uterus according to these sources 1, 2. — Preceding unsigned comment added by Spyder212 (talk • contribs)
 * Just to clarify, the only reason that is not infection related? There are multiple reasons for deep dyspareunia, correct? RyanDanielst (talk) 15:11, 8 January 2020 (UTC)


 * RyanDanielst, are you the IP? Please stick to using your account or your IP. Using both is confusing for others reading this section. Flyer22 Reborn (talk) 05:06, 8 January 2020 (UTC)
 * Will do. I didn't realize I was not logged in. Sorry about that. RyanDanielst (talk) 15:12, 8 January 2020 (UTC)

Penis Size putting Uterosacral ligaments on Stretch
I actually spoke with this gynecologist who used to work with Mayo Clinic for over 20 years. He stated that a longer penis cause dypsaruenia. To quote his site: ''The length of the vagina does not cause symptoms unless your partner is long enough to hit the top of the vagina on deep insertion. If enough pressure is applied by the penis, it places the uterosacral ligaments and overlying highly innervated peritoneum on stretch resulting in pain. Repetitive thrusts during intercourse tend to make the whole sexual episode unpleasant and more difficult to achieve orgasm. The pain tends to fade away fairly quickly after intercourse.''

Should this be added? — Preceding unsigned comment added by RyanDanielst (talk • contribs)


 * You should stick to WP:MEDRS-compliant sources. That includes sticking to MEDRS-compliant sources for this. Primary sources, like the one you added, should usually be avoided. Flyer22 Frozen (talk) 06:20, 6 April 2020 (UTC)

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