Dyspareunia Causes and TCM Dietary Treatments

Dyspareunia refers to pain in the female vulva, inside the vagina, or in the lower abdomen during sexual intercourse, which may also occur after intercourse or persist for several hours or days afterward. Based on the site of onset, it can be classified into the following types: superficial dyspareunia, where the pain is located at the level of the labia and vaginal entrance; vaginal dyspareunia, where the pain is at the level of the vaginal wall; and deep dyspareunia, which is triggered by tenderness upon deep penetration of the penis. Based on the etiology, it can be divided into two types: organic dyspareunia, where the pain is caused by local lesions, and psychogenic dyspareunia, which results from marital discord and a lack of sexual knowledge between partners.

Dyspareunia is a signs of imbalance that commonly occurs in women during sexual activity. Patients often fail to experience sexual pleasure and satisfaction due to fear of the pain caused by sexual intercourse and high levels of mental tension. Over time, this can also affect sexual relationships, leading to a gradual weakening of the marital bond.

I.Causes of dyspareunia

1.Psychological factors

Psychological factors can themselves cause dyspareunia, but they can also be a secondary consequence of organic dyspareunia. The mechanism of psychogenic dyspareunia primarily involves emotional issues that lead to insufficient sexual arousal and inadequate lubrication during intercourse. Common causes include marital discord and emotional conflicts; or a lack of sexual knowledge between both partners, causing the woman to have numerous concerns about sexual life, even feeling suppressed and embarrassed; or the man’s lack of understanding of the physiological and psychological differences between the sexes, leading to hasty intercourse before arousing the woman’s sexual desire and when the vagina lacks natural lubrication. Consequently, this creates fear and aversion in the woman’s mind, resulting in pain during or after each intercourse, thereby hindering the act of intercourse.

2. Organic factors

Acute or chronic vaginitis, vulvitis, or vulvar abrasions or hymenal tears occurring after marriage can all lead to varying degrees of congestion and swelling locally. Engaging in sexual activity under such circumstances will inevitably cause pain. Patients with cervicitis, endometritis, or pelvic inflammatory wellness may experience deep vaginal pain during intercourse due to the impact of the penis on the cervix and pelvis. In addition, congenital developmental malformations and adhesions of the vulva, vaginal scarring caused by surgery, as well as lesions of the urethra and anus near the vaginal area, and even hemorrhoids and anal fissures, can all cause pain during sexual activity.

Due to endocrine influences, women in menopause generally find it more difficult to become sexually aroused compared to younger individuals, and the excitement phase requires a longer duration. Additionally, as the female reproductive organs gradually atrophy, vaginal secretions decrease during sexual intercourse. Coupled with the thinning of the vaginal mucosa, which is prone to inflammation and abrasion, discomfort and pain may sometimes be experienced during sexual intercourse.

3. TCM understanding of the etiology of dyspareunia

In traditional Chinese medicine, it is believed that when Liver qi is stagnated, emotions are not smooth, and there is a lack of sexual desire, the vagina will not open properly. Forced sexual intercourse in such a state can cause pain. Alternatively, when there is Spleen deficiency with excessive dampness, and Liver meridian stagnation heat combines with dampness and descends, it can lead to infection by parasites. These parasites erode the vaginal area, and when combined with improper sexual conduct, it results in dyspareunia. Or, when there is an inherent deficiency of Liver and Kidney essence, or in old age with physical decline and deficiency of both essence and blood, blood deficiency can generate wind and dryness, leading to dyspareunia.

II.Syndrome Differentiation and Dietary Therapy

1.Deficiency of Kidney essence

Elderly people with a weak constitution or those with a prolonged wellness damaging the Kidney may experience a lack of nourishment in the zang-fu organs and body structures, resulting in insufficient essence and blood and dryness and astringency in the genital area. signs of imbalance include sexual indifference, vaginal dryness, a pulling pain in the vagina during sexual intercourse, accompanied by delayed menstruation, scanty and pale menstrual flow, soreness and weakness in the lower back and legs, dizziness and tinnitus, a pale red tongue, and a deep, thin and weak pulse at the chi position. The supports principle is to nourish the Kidney, replenish essence, moisten dryness, and helps with occasional pain. One can take Gouqi Yuzhu Congee.

Formula and Preparation Method: 30 grams of Lycii Fructus (Gou Qi Zi), 30 grams of Polygonati Odorati Rhizoma (Yu Zhu). Add 1000 milliliters of water and boil until the volume reduces to 300 milliliters. Then, take 2 egg yolks, mash them, and pour into the decoction. Add an appropriate amount of crystal sugar for seasoning. Consume in two divided doses throughout the day.

In the formula, Lycii Fructus (Gou Qi Zi) is a key herb for strengthening the Kidney. There is an ancient saying, “Do not eat Lycii Fructus when traveling a thousand li away from home,” indicating its ability to tonify the Liver and Kidney and nourish essence and blood. Polygonati Odorati Rhizoma (Yu Zhu) can moisten dryness and helps with occasional pain. Chicken yolk nourishes yin and blood. Therefore, this formula can supports sexual intercourse-related vulvar pain due to Kidney essence deficiency.

One can also take Niusui Gao. Formula and preparation method: 150 grams of Polygonati Rhizoma (Huangjing), 100 grams of Rehmanniae Radix (Dihuang), and 50 grams of Scrophulariae Radix (Xuanshen). Boil them together to make a decoction, remove the dregs, and concentrate it into a paste. Separately, extract 60 grams of bone marrow from cow bones (or pig bones). Mix the herbal paste with the cow bone marrow (or pig bone marrow) evenly. Each morning, take one spoonful of the mixture with warm yellow rice wine. In this formula, cow bone marrow can nourish the Kidneys and replenish essence. Supplemented by Polygonati Rhizoma and Rehmanniae Radix to replenish Kidney essence and nourish yin and blood, and Scrophulariae Radix to nourish yin, reduce fire, disperse nodules, and helps with occasional pain.

In addition, one can choose to take dietary therapy prescriptions that nourish yin and replenish essence.

2.Liver Qi Stagnation

When emotions are not smooth, the Liver fails to maintain its free flow; Liver Qi Stagnation leads to abnormal dispersion and regulation, resulting in disharmony of qi and blood. The Chong and Ren Meridians cannot nourish each other, leading to paroxysmal pain inside the vagina during sexual intercourse, which may even radiate to both lower abdominal sides and the medial aspects of the lower limbs. This is accompanied by irritability, distending pain in the chest and hypochondrium, headache, dizziness, a red tongue with a thin coating, and a wiry and tight or wiry and rapid pulse. The supports principle is to soothe the Liver and regulate qi, unblock the collaterals and helps with occasional pain. Jupi Yin (Tangerine Peel Beverage) can be taken.

Formula and Preparation Method: Pericarpium Citri Reticulatae 15 grams, Fructus Crataegi 20 grams, Retinervus Luffae Fructus 20 grams, Semen Litchi 15 grams, Fructus Jujubae 15 grams. Decoct in water and take warm, twice a day.

In the formula, tangerine peel (Citrus reticulata pericarpium) soothes the Liver and regulates qi, hawthorn fruit (Crataegus pinnatifida fructus) promotes blood circulation and removes blood stasis, loofah sponge (Luffa cylindrica reticulatum) promotes blood circulation and unblocks the collaterals, litchi seed (Litchi chinensis semen) regulates qi and helps with occasional pain, and is combined with jujube (Ziziphus jujuba fructus) to strengthen the Spleen and stomach and nourish qi and blood. Therefore, after taking it, Liver Qi Stagnation can be helps with occasional and pain can be stopped.

One can also drink kumquat tea. Formula and preparation method: 30 grams of kumquats, 10 red dates, 5 grams of licorice root, and an appropriate amount of rock sugar. Add water and stew together, then strain out the dregs and drink the liquid. One dose per day, taken in two divided doses, for 10 to 15 consecutive days.

In the formula, kumquat regulates qi and helps with occasional depression, jujube tonifies the middle-jiao and replenishes qi, and licorice root helps with occasional spasms and helps with occasional pain. Regular consumption can make Liver qi flow smoothly, eliminating the concern of vaginal pain during sexual intercourse.

3.Damp-heat pouring downward

Due to the downward flow of damp-heat, the Chong and Dai Meridians (LV01, RN02 related channels) are damaged; or infection by parasites occurs, with parasites eroding the vagina, leading to pain in the vagina during sexual intercourse. It is often accompanied by excessive vaginal discharge, which is yellow and thick, or frothy and rice-water-like in appearance, with a fishy odor. Systemic signs of imbalance mostly include restlessness, insomnia, bitter and greasy taste in the mouth, yellow and red urine or a burning sensation in the urethra, a yellow and greasy tongue coating, and a slippery and rapid pulse. The supports principle is to clear heat and resolve dampness. One can consume Cold-Mixed Three Delicacies.

Formula and Preparation Method: Take equal amounts of Portulaca oleracea (common purslane), Houttuynia cordata (Heartleaf houttuynia), and Apium graveolens (celery), wash them, blanch briefly in boiling water, then season with salt, sugar, vinegar, monosodium glutamate, and sesame oil. Serve cold as a side dish.

All three herbs in the formula can clear heat, eliminate dampness, detoxify, and kill parasites. When used in combination, they enhance the effect of clearing heat and eliminating dampness.

One can also take Yam and Bean Sprout Paste. Formula and preparation method: Take 2000 grams of fresh mung bean sprouts, 250 grams of brown sugar, and 30 grams of fresh yam. Put them all in a pot and boil until they form a paste. Then add 6 grams of ginger juice and stir well. Take 3 tablespoons each time, and consume it with boiling water on an empty stomach in the morning and evening.

In the formula, mung bean sprouts can clear heat, eliminate dampness, and detoxify; Chinese yam is used to invigorate the Spleen and replenish qi; ginger juice harmonizes the stomach and stops vomiting. Therefore, this formula is suitable for those with sexual intercourse vulvar pain of the Spleen-deficiency and damp-heat downward flow type.

III. External Folk and Proven Prescriptions

1. Triticum aestivum (floating wheat), mirabilite, alum, and Galla chinensis, 15 grams each, decoct in water, and use the decoction to wash the external genitalia before sexual intercourse.

2. Decoct Lycii Cortex (Digupi) into decoction and frequently wash the genital area.

3. Radix Saposhnikoviae 9 g, Radix Euphorbiae Pekinensis 2 g, Folium Artemisiae Argyi 15 g, decoct in water, and use the decoction to warmly wash the genital area after sexual intercourse.