II. Definitions
- Dyspareunia
- Recurrent or persistent pain on vaginal penetration
III. Epidemiology
- Prevalence: 10-20% of women in the United States
- Age: More common on younger ages
IV. Risk Factors: Contributing Psychological Factors (and complications of Dyspareunia)
-
Female Sexual Dysfunction
- Impaired sexual desire (libido)
- Decreased sexual arousal
- Anorgasmia
-
Mood Disorder
- Major Depression
- Anxiety
- Sexual abuse history
- Comorbidity
- Decreased overall health status
- Urinary tract symptoms
- Fibromyalgia
- Irritable Bowel Syndrome
- Gynecologic history
- Postpartum Status
- Perimenopausal or PostMenopausal
- Vacuum Assisted Delivery or Forceps Assisted Delivery
- Pelvic Floor Surgery
- Recent Breast Feeding
- Psychosocial factors
- Younger age
- Lower educational status (less than college degree)
- White race
- Emotional stressors
- Decrease in household income >20%
V. History
- See Chronic Pelvic Pain
- Proceed through history stepwise from least intrusive to most detailed
- Medical and surgical history
- Gynecologic and obstetric history
- Sexual History
- Sexually Transmitted Infection history
- Physical abuse or sexual abuse including Intimate Partner Violence
- Symptoms with sexual activity
- Location, intensity and duration of pain
- Associated bowel, Bladder and musculoskeletal symptoms
- Painful sexual activities
- Distinguish entry Dyspareunia from deep Dyspareunia
- Distinguish primary (from the first episode of sexual activity) and secondary Dyspareunia (later onset)
- Negative impacts of Dyspareunia
- Interpersonal relationships
- Self esteem
VI. Exam
VII. Causes
- Entry or localized pain at the vaginal introitus
- Vulvodynia or Vulvar Vestibulitis
- Vulvar burning or irritation
- Vulvar Dermatitis (Vulvar Dermatoses)
- Papulosquamous Vulvar Dermatoses (e.g. Vulvar Lichen Sclerosus et atrophicus, Vulvar Lichen Planus, Contact Dermatitis, Psoriasis)
- Bullous Vulvar Dermatoses (e.g. Erythema Multiforme, Bullous Pemphigoid, Pemphigus)
- Genital Ulcers
- Systemic disease (e.g. Behcet's Disease, Systemic Lupus Erythematosus, Reiter's Syndrome)
- Peri-vaginal infection
- Atrophic Vaginitis or impaired vaginal lubrication
- See Vaginal Dryness
- Vaginismus
- Introitus Muscles spasm on entry
- Urethral disorders or cystitis
- Urethritis symptoms
- Pelvic Floor Dysfunction
- Postpartum Dyspareunia
- Vulvodynia or Vulvar Vestibulitis
- Pain on deep vaginal penetration
- Chronic Cervicitis
- Endometriosis
- Uterine Fibroids
- Ovarian Mass
- Pelvic adhesions
- Pelvic congestion
- Retroverted Uterus
- Interstitial Cystitis
- Pelvic infection
VIII. Diagnosis
- DSM 5 now combines Dyspareunia with Vaginismus
- Dyspareunia diagnosis (and Vaginismus diagnosis) per DSM 5
- Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months
IX. Management
- See Specific causes
- See Female Sexual Dysfunction
- See Chronic Pelvic Pain Management
- See Vaginismus
- See Vulvodynia
- See Atrophic Vaginitis
- See Vaginal Dryness
X. Complications
- Sexual Dysfunction
- Relationship Distress
- Decreased quality of life
- Mood Disorder (Major Depression, Anxiety Disorder)