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Dyspareunia
Aka: Dyspareunia, Painful Intercourse
- See Also
- Female Sexual Dysfunction
- Chronic Pelvic Pain
- Vaginismus
- Vulvodynia
- Atrophic Vaginitis
- Vaginal Dryness
- Definition
- Recurrent or persistent pain on vaginal penetration
- Epidemiology
- Prevalence: 10-20% of women in the United States
- Age: More common on younger ages
- 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
- Psychosocial factors
- Younger age
- Lower educational status (less than college degree)
- Emotional stressors
- Decrease in household income >20%
- 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
- Symptoms with sexual activity
- 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
- Exam
- See Chronic Pelvic Pain
- 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
- Vaginitis
- Human Papillomavirus
- Herpes Simplex Virus
- Atrophic Vaginitis or impaired vaginal lubrication
- See Vaginal Dryness
- Vaginismus
- Introitus muscles spasm on entry
- Urethral disorders or cystitis
- Urethritis symptoms
- Postpartum Dyspareunia
- Present after first deliveries in 41% at 3 months and 22% at 6 months
- Due to sclerotic healing (e.g. perineal Stretching and Lacerations, operative vaginal deliveries)
- Exacerbated by hypoestrogenic states (e.g. Breast Feeding) and psychosocial factors leading to decreased arousal
- Treat Vaginal Dryness as a first-line therapy
- Revision perineoplasty has been used in severe, refractory cases
- Pain on deep vaginal penetration
- Chronic Cervicitis
- Endometriosis
- Uterine Fibroids
- Pelvic adhesions
- Pelvic congestion
- Retroverted Uterus
- Interstitial Cystitis
- Pelvic infection
- Endometritis
- Pelvic Inflammatory Disease
- 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
- Management
- See Specific causes
- See Female Sexual Dysfunction
- See Chronic Pelvic Pain Management
- See Vaginismus
- See Vulvodynia
- See Atrophic Vaginitis
- See Vaginal Dryness
- References
- Heim (2001) Am Fam Physician 63(8):1535-44 [PubMed]
- Seehusen (2014) Am Fam Physician 90(7): 465-70 [PubMed]