Intimate medicine for women in Paris



Dr Adriana guzman à Paris


The term “dyspareunia” comes from the Greek dys meaning “difficulty” and pareunia meaning “mating”.


It is therefore a pain that appears at the time of sexual intercourse. Dyspareunia is characterized by the time at which the pain occurs (the time of the sexual act) rather than by the anatomical location of the pain (to have pain in the lower abdomen during menstruation is not a dyspareunia).


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The term is used both for men and for women. It involves about 3 % of couples and is a compelling reason for consultation

The pain tolerance threshold can be crossed due to these pains invading the proper functioning and harmony of the couple. In the absence of care, the desire will gradually collapse.

For women these dyspareunia can be occasional, chronic, affect only a part of the genital tract or the whole, but in any case it affects the psyche when discomfort or even pain become strongly present and obsessive.

The causes of dyspareunia vary, but the possibility of identifying them during coitus and even afterwards facilitates detection and treatment


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Questions are asked about the gynecological and obstetric history as well as the type of contraceptive past and present. The history of sexuality is taken into account: successes and failures, current feelings about these disappointments, the state of the couple, repercussions on sexuality.


A medical examination is necessary in order to eventually screen for herpes, painful scar tissue, ulceration, infection, annular fissures, malformation of the vulva, postmenopausal vaginal dryness and chronic irritations.

The vagina, the cervix (infection), the uterus (endometriosis), a tear of the ligaments during childbirth should not be neglected, and neither should signs of colitis or constipation.

If the medical specialist cannot identify an organic cause, it is necessary to turn to a sex therapist in order to avoid venturing in the psychosomatic maze alone.


There are many possible psychological causes: a strict education instilling a guiltiness when indulging in pleasure, or conflicting relations with the partner to whom it is sometimes easier to say “it hurts” than “I do not want sex”. Possible causes also include the rejection of sexuality of femininity in general, fear of man or repercussions from sexual assault, and sexual dysfunction from the partner (premature ejaculation, erectile dysfunction and anejaculation).

Physiological dyspareunia should be diagnosed and treated on a medical basis. The partner is encouraged to be patient, gentle, and composed, which is not always easy and requires therapeutic work.

When the causes of dyspareunia are psychological, a dialogue is established between the patient and the sex therapist. The latter may resort to relaxation, to the visualization of a pleasant and painless amorous scene, to pedagogy on sexuality and anatomy.
The notion of female orgasm is also to be taken into account: women may start to experience pleasure in an area that was previously a mere source of pain and dissatisfaction.

It is preferable for both partners to be involved in this undertaking, in couple sessions for example, alternated by individual sessions for each partner.