II. Epidemiology

  1. Dyspareunia present after first deliveries in 41% at 3 months and 22% at 6 months

III. Symptoms

  1. Dyspareunia following Vaginal Delivery
  2. Exacerbated by Vaginal Dryness (treat with Vaginal Lubricant as first line therapy)
    1. Hypoestrogenic states (e.g. Breast Feeding)
    2. Psychosocial factors leading to decreased arousal

IV. Differential Diagnosis

  1. See Dyspareunia
  2. See Female Sexual Dysfunction
  3. Vulvodynia (Pelvic Floor Muscle Tenderness, Pelvic Floor Dysfunction)
  4. Infection (e.g. Vaginitis)

V. Management

  1. See Dyspareunia
  2. Exclude other causes (see above)
  3. Vaginal Lubricant (first-line)
  4. Revision perineoplasty has been used in severe, refractory cases
    1. Painful perineal scarring
    2. Granulation tissue
    3. Laceration breakdown
    4. Significant anatomic distortion
    5. Poorly healed perineal Lacerations

VI. Prognosis

  1. Prolonged course due to sclerotic healing (e.g. perineal Stretching and Lacerations, operative vaginal deliveries)

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