Dyspareunia (Painful Intercourse), Primary

What Is Primary Dyspareunia (Painful Intercourse)?

[dropcap]D[/dropcap]yspareunia is a distressing female genital disorder characterized by pain during or after coitus involving the labia, vagina or pelvis.

There are two types of dyspareunia: primary which affect the vagina itself in the abscence of pelvic pathology and secondary which involves problems in the pelvis other than the vagina.¹

• Causes of primary dyspareunia include hormone changes in menopause, Sjogrens syndrome, diabetes, psychological conditions, and nutritional deficiencies.
• Causes of secondary dyspareunia include problems with uterus, bowel disease, urinary tract infection, uterine prolapse, and pelvic disease such as endometriosis and cancer.

Q: How common is dypareunia?

A: Dyspareunia is the most common cause of pelvic pain in women.²

What Is Dyspareunia In Celiac Disease and/or Gluten Sensitivity?

• Dyspareunia is an atypical symptom of celiac disease and may be an uncommon presenting feature of untreated celiac disease.
• Dyspareunia develops from vitamin D deficiency in celiac disease.
• Vaginal inflammation, which makes the lining sore, may be complicated by opportunistic infections, such as monilia, which is an associated disorder of celiac disease, or bacteria from the GI tract.

How Prevalent Is Dyspareunia In Celiac Disease and/or Gluten Sensitivity?

Prevalence of dyspareunia in association with celiac disease has been shown by case reports.³

What Are The Symptoms Of Dyspareunia?

Dyspareunia is marked by these symptoms:

• Painful coitus.
• Possible repeat vaginal infections due to loss of mucosal integrity.

How Does Dyspareunia Develop In Celiac Disease and/or Gluten Sensitivity?

• Dyspareunia results from deficiencies of vitamin D in celiac disease that cause peeling inflammation of the vaginal mucosa.

In vitamin D deficiency, a resulting desquamative (peeling) inflammation of the vaginal mucosa causes the dyspareunia. Moreover, it is suggested that the loss of this epithelium leads to altered vaginal pH levels, mucous membrane fragility, inflammation, and secondary infection.

Because vitamin D is a known transcriptional activator, it is suggested that vitamin D is necessary for the synthesis of specific vaginal structural proteins, such as cytokeratins. Vitamin D deficiency results in decreased amounts of these proteins, resulting in loss of epithelial structural integrity and desquamation. Correction of the vitamin D deficiency ultimately leads to regeneration of the vaginal epithelium and cessation of desquamation.⁴

• Niacin deficiency is a cause of non-infectious vaginitis because niacin is required for a healthy mucosal lining.
• Inadequate vaginal lubrication, vaginal atrophy, and uterine myomata due to the effects of gluten.

Does Dyspareunia Respond To Gluten-Free Diet?

Yes. Dyspareunia completely responds to gluten free diet.⁵

6 Steps To Improve Dyspareunia In Celaic Disease:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both dyspareunia and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁷[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain prescription drugs that deplete vitamin D that can cause dyspareunia and niacin that impairs the mucosa health. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B3. Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the study participants.⁸

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin D.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Vitamin D.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin D.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin D.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin D.

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin D.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Vitamin D3 as prescribed following blood test for status.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Dyspareunia In Celiac Disease and/or Gluten Sensitivity?

“Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia.” This case report of a 43 year old woman with chronic abdominal pain and pelvic pain, deep dyspareunia, dysmenorrhea, diarrhea, and a 5 kg weight loss during the last 6 months describes failure of surgical intervention followed by complete success with gluten free diet therapy. At laparoscopy, numerous small leiomyomata were seen and a few filmy adhesions between the small bowel and the abdominal wall were lysed. Except for the deep dyspareunia, all symptoms remitted after surgery, only to recur at 6 months of follow-up. Subsequently, celiac disease was diagnosed and a gluten free diet prescribed on which the patient became free of symptoms.³

Sources:

1. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341-6. [↩]
2. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341-6. [↩]
3. Porpora MG, Picarelli A, Prosperi Porta R, Di Tola M, D’Elia C, Cosmi EV. Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia. Obstetrics and Gynecology. 02 May;99(5 Pt 2):937-9. [↩] [↩]
4. Peacocke M, Djurkinak E, Thys-Jacobs S. Treatment of desquamative inflammatory vaginitis with vitamin D: a case report. Cutis. 2008 Jan;81(1):75-8. [↩]
5. Porpora MG, Picarelli A, Prosperi Porta R, Di Tola M, D’Elia C, Cosmi EV. Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia. Obstetrics and Gynecology. 02 May;99(5 Pt 2):937-9. [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
8. Akinloye O1, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J. 2011 Jun;60(3):308-15. [↩]