Dyspareunia and its relationship with estrogenic changes and sexual dysfunction of women in the second half of pregnancy

Document Type : Original Article


1 Post-doctoral student in Psychosomatic, Psychiatric and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 M.Sc. of Clinical Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.

3 M.Sc. of Clinical Psychology, Psychiatric and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 M.Sc. of Clinical Psychology, School of Psychology and Physical Education Sciences, Urmia Branch, Islamic Azad University, Urmia, Iran.

5 PhD Student in Psychology, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran.


Introduction: Dyspareunia or pain during intercourse is one of the problems which some women experience. This problem becomes more severe during pregnancy. Therefore, this study was performed with aim to investigate dyspareunia and its relationship with estrogen changes and sexual dysfunction in pregnant women.
Methods: This descriptive cross-sectional study was performed in 2018-2019 on 50 pregnant women referring to obstetrics and gynecology clinics and also clinical psychologists in Mashhad who had dyspareunia as the case group and 50 normal and non-infected pregnant women as the control group. Also, pregnant women were at the interval between the fourth and fifth months of pregnancy. Data collection tool included demographic information, the structured clinical interview measurement tool for disorders I and II and DSM-IV, the standard Female Sexual Function Index sexual performance questionnaire, and disease-related information included in the researcher-made checklist. Data were analyzed using SPSS statistical software (version 16) and Pearson correlation coefficient test. P<0.05 was considered statistically significant.
Results: The results showed that the mean score of total sexual function in the clinical group was 6.84±5.65 and the score of dyspareunia was 5.46±4.22; the scores of the case group were much higher than the control group. Also, the level of estrogen in pregnant women with dyspareunia decreased compared to pregnant women without dyspareunia and was 21.68±12 12.04 in the case group and 36.21±18.12 in the control group that significant difference was found between the two groups in terms of estrogenic changes.
Conclusion: Low estrogen level is effective in causing dyspareunia. Also, the history of dyspareunia was associated with sexual dysfunction; so that the total score of sexual function and estrogen level was lower in the patient group than the normal group. What increases the prevalence of dyspareunia is a history of sexual dysfunction. In general, women in the control group had better score in sexual function and lower score in painful intercourse, and had no particular problem.


  1. Easley EB. Sex problems after the menopause. Clinical obstetrics and gynecology 1978; 21(1):269-78.
  2. Bachmann G. The estradiol vaginal ring—a study of existing clinical data. Maturitas 1995; 22:S21-9.
  3. Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. The journal of sexual medicine 2005; 2:154-65.
  4. Meunier V, Baker W. Positive couple relationships: The evidence for long-lasting relationship satisfaction and happiness. InPositive relationships 2012:73-89.
  5. Karamidehkordi A, Roudsari RL. Body image and its relationship with sexual function and marital adjustment in infertile women. Iranian journal of nursing and midwifery research 2014; 19(7 Suppl1):S51.
  6. Kao A, Binik YM, Kapuscinski A, Khalifé S. Dyspareunia in postmenopausal women: a critical review. Pain Research and Management 2008; 13(3):243-54.
  7. Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. The journal of sexual medicine 2005; 2:154-65.
  8. Maartens LW, Leusink GL, Knottnerus JA, Smeets CG, Pop VJ. Climacteric complaints in the community. Family practice 2001; 18(2):189-94.
  9. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. American journal of obstetrics and gynecology 2001; 185(3):545-50.
  10. Babula O, Lazdāne G, Kroica J, Linhares IM, Ledger WJ, Witkin SS. Frequency of interleukin-4 (IL-4)-589 gene polymorphism and vaginal concentrations of IL-4, nitric oxide, and mannose-binding lectin in women with recurrent vulvovaginal candidiasis. Clinical infectious diseases 2005; 40(9):1258-62.
  11. Payne KA, Binik YM, Amsel R, Khalifé S. When sex hurts, anxiety and fear orient attention towards pain. European journal of pain 2005; 9(4):427-36.
  12. Hayes R, Dennerstein L. The impact of aging on sexual function and sexual dysfunction in women: A review of population‐based studies. The journal of sexual medicine 2005; 2(3):317-30.
  13. Caruso S, Monaco C. Dyspareunia in women: updates in mechanisms and current/novel therapies. Current Sexual Health Reports 2019; 11(1):9-20.
  14. Najar S, Yaralizadeh M, Abedi P, Namjooyan F. Effect of fennel vaginal cream on dysparonia and sexual satisfaction among postmenopausal women: a double-blind randomized controlled trial. Iran J Obstet Gynecol Infertil 2015; 18(171):8-16.
  15. Pazmany E, Bergeron S, Van Oudenhove L, Verhaeghe J, Enzlin P. Body image and genital self-image in pre-menopausal women with dyspareunia. Archives of sexual behavior 2013; 42(6):999-1010.
  16. Caruso S, Serra A, Grillo C, De Leo V, Maiolino L, Agnello C, et al. Prospective study evaluating olfactometric and rhinomanometric outcomes in postmenopausal women on 1 mg 17β-estradiol and 2 mg drospirenone HT. Menopause 2008; 15(5):967-72.
  17. Villa P, Amar ID, Bottoni C, Cipolla C, Dinoi G, Moruzzi MC, et al. The impact of combined nutraceutical supplementation on quality of life and metabolic changes during the menopausal transition: a pilot randomized trial. Archives of gynecology and obstetrics 2017; 296(4):791-801.
  18. Nappi RE, Panay N, Bruyniks N, Castelo-Branco C, De Villiers TJ, Simon JA. The clinical relevance of the effect of ospemifene on symptoms of vulvar and vaginal atrophy. Climacteric 2015; 18(2):233-40.
  19. Nappi RE, Cagnacci A, Becorpi AM, Nappi C, Paoletti AM, Busacca M, et al. Monurelle Biogel® vaginal gel in the treatment of vaginal dryness in postmenopausal women. Climacteric 2017; 20(5):467-75.
  20. Andrews G. Women's sexual health. 3nd ed. Philadelphia: Elsevier Health Sciences; 2005.
  21. Oakley A, Fullerton D, Holland J, Arnold S, Dawson MF, Kelley P, et al. Sexual health education interventions for young people: a methodological review. Bmj 1995; 310(6973):158-62.
  22. Beigi M, Javanmardi Z, Abdolahi M. A study on women’s sexual functioning disorders before and after menopause. Avicenna Journal of Nursing and Midwifery Care 2008; 16(2):37-47.
  23. Abdo CH, Oliveira WM, Moreira ED, Fittipaldi JA. Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women—results of the Brazilian study on sexual behavior (BSSB). International Journal of Impotence Research 2004; 16(2):160-6.
  24. Bakhtiari M, Sheydaei H, Bahreynian SA, Nori M. The effect of cognitive-behavioral therapy on low sexual desire and marital satisfaction. Thoughts and Behavior in Clinical Psychology 2015; 10(36):7-16.
  25. Salari P, Nayebi-Niya AS, Modarres Gharavi M, Vahid-Roudsari F, Jabbari Nooghani H. Surveying the relationship between adult attachment style to parents with female sexual function. Journal of Fundamentals of Mental Health 2012; 13(4):346-55.
  26. Gagnon J, Simon W. Sexual conduct: the social sources of human sexuality. 2nd ed. New Brunswick N.J.: AldineTransaction; 2005.
  27. Thompson S. Going all the way : teenage girls' tales of sex, romance, and pregnancy. 1nd ed. New York: Hill and Wang; 1995.
  28. Berek JS. Pelvic pain and dysmenorrhea. In: Berek JS, editor. Berek and Novak's Gynecology. 15nd ed. Wolters Kluwer: Lippincott Williams and Wilkins; 2012.
  29. Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Williams Gynecology. 2nd ed. New York: McGraw-Hill; 2012.
  30. Fisher KA. Management of dyspareunia and associated levator ani muscle overactivity. Physical therapy 2007; 87(7):935-41.
  31. Edwards WM, Coleman E. Defining sexual health: a descriptive overview. Archives of sexual Behavior 2004; 33(3):189-95.
  32. Pereira VM, Arias-Carrión O, Machado S, Nardi AE, Silva AC. Sex therapy for female sexual dysfunction. International archives of medicine 2013; 6(1):1-9.
  33. ter Kuile MM, Both S, van Lankveld JJ. Cognitive behavioral therapy for sexual dysfunctions in women. Psychiatric Clinics 2010; 33(3):595-610.
  34. Colling ML. Female Hypoactive Sexual Desire Disorder. A Summary Paper Presented to the Faculty of the Adler Graduate School; 2011.
  35. Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of sexual behavior 2010; 39(2):221-39.
  36. Karimi Afshar H. = Clinical evaluation of bucoadhesive paste containing trigonella foenum graecum liquid extract in comparison to control (Doctoral dissertation, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran). School of Pharmacy, Kerman University of Medical Sciences; 2015
  37. Motamed N, Zamani F. Sample size in medical research: with a practical approach. Tehran: Asre Roshanbini; 2016. P. 17-22.
  38. Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). Arch Gen Psychiatry 1992; 49(8):624-9.
  39. Sharifi V, Asadi SM, Mohammadi MR, Amini H, Kaviani H, Semnani Y, et al. Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID). Advances in cognitive science 2004; 6(1):10-22.
  40. Forouhari S, Safari Rad M, Moattari M, Mohit MI, Ghaem H. The effect of education on quality of life in menopausal women referring to Shiraz Motahhari clinic in 2004. Journal of Birjand University of Medical Sciences 2009; 16(1):39-44.
  41. Rosen C, Brown J, Heiman S, Leiblum C, Meston R, Shabsigh D, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of sex & marital therapy 2000; 26(2):191-208.
  42. Mohammadi KH, Heydari M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. Payesh 2008; 7(3):269-78.
  43. Leiblum S, Bachmann G, Kemmann E, Colburn D, Swartzman L. Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. Jama 1983; 249(16):2195-8.
  44. Fava GA, Sonino N, Wise TN, editors. The psychosomatic assessment: strategies to improve clinical practice. Karger Medical and Scientific Publishers; 2011.
  45. Goldstein SW, Winter AG, Goldstein I. Improvements to the vulva, vestibule, urethral meatus, and vagina in women treated with ospemifene for moderate to severe dyspareunia: a prospective vulvoscopic pilot study. Sexual medicine 2018; 6(2):154-61.
  46. Meier ML, Vrana A, Humphreys BK, Seifritz E, Stämpfli P, Schweinhardt P. Pain-related fear—dissociable neural sources of different fear constructs. eneuro 2018; 5(6).