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Try out PMC Labs and tell us what you think. Learn More. Sexual violence is a ificant public health problem in the United States. In an effort to decrease the incidence of sexual assault, legislators have passed regulatory laws aimed at reducing recidivism among convicted sexual offenders. As a result, sex offenders living in the United States are bound by multiple policies, including registration, community notification, monitoring via a global positioning system, civil commitment, and residency, loitering, and Internet restrictions. These policies have led to multiple collateral consequences, creating an ominous environment that inhibits successful reintegration and may contribute to an increasing risk for recidivism.


Nothing that hurts is very fun.

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Along with this pain can come many feelings including worry, embarrassment, and self-consciousness. Many also feel as though they are alone when they experience this. Women should be reassured that they are not alone in feeling pain with intercourse. This problem is more than just physical. It is a complicated and intertwined with many facets of life, and thus, affects all women differently.

Contributors to dyspareunia include emotional factors, hormones, personal history, medical history, and much more. Painful intercourse used to be classified as a sexual disorder, rather than a pain disorder. Many attributed sexual pain largely to a result of subconscious aversion, fear, anxiety, depression, and other psychological issues.

Recently studies have shown that dyspareunia is actually a complicated subject and though psychology plays a part, it is not usually the biggest contributor Women want sex Cotter sexual pain. Studies have had very different. Some show that women with dyspareunia did have more depression, anxiety, and fear, while others showed that women with dyspareunia were no different than the general population in terms of these psychological traits.

Another interesting find is that ly, women with a current or history of sexual abuse were thought to have more pain with intercourse, but several studies have shown that this is not true.

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Again, it is possible for this to be a factor in pain with intercourse, but it is not a determinant. All of these studies and more are beginning to shift the popular opinion away from the thought that women who experience pain with intercourse have this pain because of some psychological issue. These three factors affect and simultaneously worsen each other. Your social situation may affect how you feel which may cause you to produce less lubrication and have more painful intercourse.

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Or, you may have a painful incident which causes you to become stressed which then causes your relationship to suffer which then causes you to become disinterested in sex. When you come to the office, taking your history and doing an examination will allow us to find out the cause of your painful intercourse together. Because the topic is complicated and involves several aspects, it is important to be upfront about your specific issues and history so that when combined with a physical examination, the answer is clear.

There are many potential physical causes of dyspareunia. First, it may be best to determine if pain occurs at the opening or outside of the vagina, or if the pain occurs deep inside.

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These are respectively referred to as Superficial Pain and Deep Pain. If you have not already been diagnosed but experience some of these symptoms, it's a good idea to come into the office. Vulvodynia: This refers to pain anywhere in the vulva, or the external vaginal area that includes your inner and outer lips, clitoris, etc. Often it is associated with other pain syndromes like fibromyalgia and interstitial cystitis. Typically pain occurs first with sexual contact, but may also be present in other activities such as wiping after the bathroom. Vulvodynia is different from other causes of vaginal pain and is not related to yeast, bacteria, vulvar skin problems, or others.

Women will usually have tried many treatments that have been unsuccessful in the past. Calcium Citrate is a supplement that may help Vulvodynia. It may also be treated sometimes with antidepressants or medications for a condition called neuropathy. Lastly, physical therapy can sometimes improve vulvodynia. Vulvar Vestibulitis: This is a type of vulvodynia and it is a constant and painful swelling of the vaginal opening. Women will commonly feel pain with penetration if this is the cause.

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Vulvar Vestibulitis may occur for several reasons, but much is still unknown. Skin Problems : There are several vulvar skin disorders that may be a cause of pain including ulcers, eczema, cracks in the skin, and allergies to substances like soaps, lubricants, synthetic underwear, etc.

Another skin problem that may cause dyspareunia is a condition called lichen sclerosis. Vaginitis: Vaginitis means inflammation of the vagina and there are many types and causes of vaginitis.

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The most common causes are yeast, bacteria, and trichomonas. These three causes of vaginitis may be treated.

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There are other types of vaginitis as well, some that may be treated with medication and others that need a change in lifestyle. Urethritis: This refers to inflammation or swelling of the urethra and is another potential cause of superficial pain.

Vaginal Atrophy: Vaginal Atrophy is actually a type of Vaginitis and it is the thinning and tightening of the vaginal walls due to loss of estrogen. This is a common problem for menopausal women or women who are breast feeding. Vaginal atrophy is well managed and treated with vaginal Estrogen creams or a system wide estrogen replacement.

Other nonhormonal options are available, however these are usually less effective. Osphena is one nonhormonal option that may improve vaginal moisture. Virgin coconut oil may also help bring some moisture to the area, and Replens is another over the counter vaginal moisturizer.

This laser treatment restores healthy moisture and elasticity to your tissues. Inadequate Lubrication: Inadequate lubrication may occur for several reasons, and large players are psychological factors.

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If you are disinterested in sex, distracted, anxious, or another emotional or mental reason, you are much less likely to produce your own natural lubrication that is necessary for intercourse. Some women will also complain that birth control pills with high Progestin levels will cause them to be more dry, vaginally.

Over the counter lubricants are an excellent way to combat this cause of pain.

My favorite lubricant to recommend is the original Astroglide. Childbirth: During childbirth, it is possible to have some tearing. This is typically repaired with a few stitches and is referred to as an episiotomy. This pain will usually resolve, but sometimes it may take up to several months after giving birth.

If you have had unprotected sex or have had multiple sexual partners and have not been recently examined, this may be a potential cause of your sexual pain. When this occurs, they become tender and painful.

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Thus, this may be a cause of dyspareunia at the vaginal opening. Endometriosis: Endometriosis is a condition where the lining of the uterus moves outside the uterus, typically still in the pelvic region. Most commonly, endometrial tissue can be found on ovaries, fallopian tubes, and other structures in between.


This endometrial tissue can occasionally be found in other areas, however this is rare. Endometriosis suspected through history and exam but can only be confirmed via surgery at my office I recommend laparoscopy. Sometimes an ultrasound will discover endometriosis cysts on the ovaries, but typically ultrasound is a poor method to diagnosis endometriosis.

Adenomyosis: Adenomyosis is a condition similar to endometriosis, however rather than endometrial tissue leaving the uterus, endometrial tissue begins to grow within the layers of muscle of the uterus. Adenomyosis, like Endometriosis, is always suspected with history, exam, and ultrasound, but ultimately confirmed and diagnosed via laparoscopy surgery. Pelvic Adhesions: Pelvic adhesions are usually cased from scar tissue that attaches and binds to other organs. When this occurs in the pelvic region, it may be a cause of dyspareunia.

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If you have had surgery in your pelvic region, especially non laparoscopic surgeries, it is possible that you may have scar tissue and adhesions. Adhesions can also be caused by endometriosis or a pelvic infection such as PID. Ovarian Problems: Some ovarian problems such as certain ovarian cysts may cause dyspareunia with deep penetration. All women will normally have ovarian cysts that come and go because it is a natural part of ovulation and menstruation, but other cysts are abnormal. Retroverted Uterus: Retroverted Uterus is a uterus that is tilted toward your spine, rather than your belly button like the average uterus.

Though it is normal to have a retroverted uterus, and many women do have one, it may be a cause of sexual pain with deep penetration. No treatment is necessary for a retroverted uterus. Pain for this reason may be prevented by avoiding the sexual positions that cause the pain. Bladder or Urinary Tract Infections: When you have a bladder or urinary tract infection, these structures are typically inflamed and swollen. This will cause them to feel discomfort if bumped during sexual intercourse.

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Typically these have other symptoms including frequent urination and burning after urination and is easily treated with an antibiotic. It is a problematic condition that is dangerous if left untreated. Therefore, if you have had unprotected sex, multiple sexual partners, or a non-monogamous relationship, you are at a greater risk of these STIs and PID.

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In an excellent piece that recently appeared on the opinion of the Harvard Crimson, Crimson editorial executive Michael F.