The various causes of dryness of vagina during the sexual intercourse experience in the past.

Sexual aversion disorder & female sexual arousal disorder are as follows: Lack of enjoyment during intercourse Dryness of vagina during coitus is also called female sexual excitation & arousal disorder, it is characterized by minimal vaginal lubrication or no lubrication at all during sexual excitation along with the absence of a feeling of excitation. In one study many women complained of lack of sexual arousal so that they get very little lubrication & vagina does not relax so that sexual intercourse is painful. In population, many women complain of difficulty in getting excited. Many such women complain of the absence of orgasm & sex may even be painful. It can be from the beginning of sexual life or may start later in life. In some arousal may be absent with one partner whereas it is normal with other partners.

Causes of Dryness of vagina during coitus

    • Hormones Disorder: Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies) Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias, Hypogonadotropics states: Hypothalamic – pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Ovarian Dysfunctions Hypothyroidisms Untreated endocrinopathies & Diabetics Glucorticoids excess, Cushing’s disease, Addisons disease
    • Excess asthenia i.e. chronic asthenia is also a significant cause of low sexual excitation & arousal.
    • chronic vulvo-vaginitis, and chronic urethritis.
    • It may also occur following any previous painful penetration of penis i.e. painful sexual intercourse or painful entry of some other object as a painful examination of the vagina by the doctor with some instrument or by some trauma
    • Addiction as chronic alcoholism, chronic smoker, heroin or cannabis use.
    • Drugs: Sedative: Narcotics, tranquilizers, amphetamine, cocaine, many antidepressants, and antipsychotics, antihypertensives, many other drugs.
    • Psychiatric disorder as depression, neurosis, & many other psychiatric disorders.
    • Any kind of sexual dysfunction in man leading to non-enjoyment of a sexual act by the female may lead to absent arousal & excitement.
    • Any cause of painful sexual intercourse (as due to vaginismus or dyspareunia) will also lead to secondary loss of excitation in women whether married or unmarried.
    • Decreased blood supply to the vagina due to various medical conditions can lead to diminishing vaginal lubrication, pain during intercourse
    • infections: in the genital tract or vulvae vestibule, vulvovaginitis
    • Less lubrication due to various reasons as hormone deficiency
    • Connective tissue diseases leading to dryness
    • Psychological problems: as depression & other psychiatry disorders
    • Sicca syndrome
    • Idiopathic
    • Any ulcerative lesions of the vagina as chronic lichen planus, herpes genitals, Pemphigus Vulgaris of the vagina
    • Decreased blood supply to the vagina due to various medical conditions can lead to diminishing vaginal lubrication, pain during intercourse
    • Vulvar vestibulitis
    • Restrictive upbringing, Inadequate sexual information, early insecurity in psychosexual role
    • Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post-surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum
    • Idiopathic vulvodynia
    • Disorders of sex center: In the brain, there is a particular center in the hippocampus part of the forebrain, which regulates the desire of sex. Sex center has some well-defined portion, which controls different component of normal sexuality These are as follows as one part of sex center controls sexual desire other parts controls excitation i.e. lubrication in response to sexual excitation, time is taken in orgasm & enjoyment of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to dryness of vagina during intercourse in response to sexual stimuli. This occurs due to arousal & excitation-controlling portions of the sex center do not work properly so that in spite of \not having any physical or mental disorders the patient does not gets sexually excited. Beside absent excitation, the patient may sexually otherwise be fit or may be suffering from some other sexual disorder.

The causes of sex centre dysfunction can be divided into two groups:

      • Immediate Cause
      • Remote Causes.

Such a classification is helpful in the treatment of absent excitation. If the absent excitation & arousal is due to immediate causes, a removal of these factors results in adequate excitation & lubrication & enjoyment by women. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure.

DIAGNOSIS OF CAUSE

Onset: We take detailed history, as for duration of absence of sexual excitation & arousal whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. How is the response of previous treatment? Response to previous therapy, pain during sex, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

DETAILED HISTORY

Onset: We take detailed history, as for duration of absence of sexual excitation & arousal whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. How is the response of previous treatment? Response to previous therapy, pain during sex, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

EXAMINATION OF GENITALS

We examine whether any Sexual Development defect is present or not. The vagina is examined for some local problem. If the vaginal examination is very painful with accompanied spasm is proof of the some local cause. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of vagina is assessed by, palpating texture of vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes. Then other systems of body are also examined.

DIAGNOSTIC TESTS

At sexologist clinic in Delhi, we have all the facility for a complete investigation of the cause of dryness of vagina during intercourse& other difficulties. So we perform following tests, step by step depending on their need based on history & examination.

The various diagnostic tests needed/performed are as follows: –

      • Complete sex hormones profile as Estradiol, SHBG, etc.
      • Thyroids test
      • Serum prolactins
      • Androgen levels
      • Investigation for systemic diseases
      • Other tests which may be required depending on likelihood of the any of above causes.
      • Detailed Sex Counseling: detailed sex counseling session, in which our male & female sex counselors meet with respective patient, talking in detail resulting in detection of primary cause leading to absence of sexual excitation & arousal.
      • In biochemistry Tests as liver function or kidney function tests are done.
      • These tests confirm the diagnosis of absence of sexual excitation & arousal confirmed.

Treatment

After the diagnosis of cause of dryness of vagina during intercourse is made, treatment includes medicines to cure the basic cause.

        • Hormone therapy: When female sex hormone deficiency is found or disorder of other glands the correction of hormone dysfunction is done. Hormone therapy is very effective in curing dryness of vagina during intercourse, when hormone is the cause for absence of sexual excitation & arousal. It is given in the form of oral tablets. Skin cream, local application of gels. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sexual excitation in many patients in whom no hormone disorder is found,
        • Sex therapy is offered in which we teach the patient about the various techniques in such a way that it increase the enjoyment of body touch better excitation & arousal in female. This leads to good lubrication of vagina thus women enjoys the sex more pleasurable. Due to this more enjoyment of sex leads to women getting orgasm more often. All this improves the dryness of vagina during intercourse as well as enjoyment of sex.
        • Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results.
        • Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in sexual excitation & arousal.
        • Stop Offending drugs which patients is consuming is identified after detailed history & drug challenge is discontinued with permanent cure of the absence of sexual excitation & arousal.
        • Treatment of psychiatric disorder are diagnosed & treated.
        • Oral supplement of DHEAS is also effective.
        • Treat other systemic disease when they are detected.

Response of Treatment

When treated is started after the diagnosis of the cause. After appropriate drug therapy, sex education & sex therapy patient recover in two months time. The dryness of the vagina during intercourse of patient recovers. After the return of dryness of vagina during intercourse to normal her family relationship also normalizes.

Side Effects

It has no side effects if given in proper doses and in-patients when it is really indicated. This is absolutely safe when given by our qualified doctors, in proper doses.