Dyspareunia

1. See Also
   1. Female Sexual Dysfunction
   2. Chronic Pelvic Pain
   3. Vaginismus
   4. Vulvodynia
   5. Atrophic Vaginitis
   6. Vaginal Dryness
   7. Postpartum Dyspareunia
2. Definitions
   1. Dyspareunia
      1. Recurrent or persistent pain on vaginal penetration
3. Epidemiology
   1. Prevalence: 10-20% of women in the United States
   2. Age: More common on younger ages
4. Risk Factors: Contributing Psychological Factors (and complications of Dyspareunia)
   1. Female Sexual Dysfunction
      1. Impaired sexual desire (libido)
      2. Decreased sexual arousal
      3. Anorgasmia
   2. Mood Disorder
      1. Major Depression
      2. Anxiety
   3. Sexual abuse history
   4. Comorbidity
      1. Decreased overall health status
      2. Urinary tract symptoms
      3. Fibromyalgia
      4. Irritable Bowel Syndrome
   5. Gynecologic history
      1. Postpartum Status
      2. Perimenopausal or PostMenopausal
      3. Vacuum Assisted Delivery or Forceps Assisted Delivery
      4. Pelvic Floor Surgery
      5. Recent Breast Feeding
   6. Psychosocial factors
      1. Younger age
      2. Lower educational status (less than college degree)
      3. White race
      4. Emotional stressors
      5. Decrease in household income >20%
5. History
   1. See Chronic Pelvic Pain
   2. Proceed through history stepwise from least intrusive to most detailed
   3. Medical and surgical history
   4. Gynecologic and obstetric history
   5. Sexual History
   6. Sexually Transmitted Infection history
   7. Physical abuse or sexual abuse including Intimate Partner Violence
   8. Symptoms with sexual activity
      1. Location, intensity and duration of pain
      2. Associated bowel, Bladder and musculoskeletal symptoms
      3. Painful sexual activities
      4. Distinguish entry Dyspareunia from deep Dyspareunia
      5. Distinguish primary (from the first episode of sexual activity) and secondary Dyspareunia (later onset)
   9. Negative impacts of Dyspareunia
      1. Interpersonal relationships
      2. Self esteem
6. Exam
   1. See Chronic Pelvic Pain Exam
7. Causes
   1. Entry or localized pain at the vaginal introitus
      1. Vulvodynia or Vulvar Vestibulitis
         1. Vulvar burning or irritation
      2. Vulvar Dermatitis (Vulvar Dermatoses)
         1. Papulosquamous Vulvar Dermatoses (e.g. Vulvar Lichen Sclerosus et atrophicus, Vulvar Lichen Planus, Contact Dermatitis, Psoriasis)
         2. Bullous Vulvar Dermatoses (e.g. Erythema Multiforme, Bullous Pemphigoid, Pemphigus)
         3. Genital Ulcers
         4. Systemic disease (e.g. Behcet's Disease, Systemic Lupus Erythematosus, Reiter's Syndrome)
      3. Peri-vaginal infection
         1. Vaginitis
         2. Human Papillomavirus
         3. Herpes Simplex Virus
      4. Atrophic Vaginitis or impaired vaginal lubrication
         1. See Vaginal Dryness
      5. Vaginismus
         1. Introitus muscles spasm on entry
      6. Urethral disorders or cystitis
         1. Urethritis symptoms
      7. Pelvic Floor Dysfunction
      8. Postpartum Dyspareunia
   2. Pain on deep vaginal penetration
      1. Chronic Cervicitis
      2. Endometriosis
      3. Uterine Fibroids
      4. Ovarian Mass
      5. Pelvic adhesions
      6. Pelvic congestion
      7. Retroverted Uterus
      8. Interstitial Cystitis
      9. Pelvic infection
         1. Endometritis
         2. Pelvic Inflammatory Disease
8. Diagnosis
   1. DSM 5 now combines Dyspareunia with Vaginismus
   2. Dyspareunia diagnosis (and Vaginismus diagnosis) per DSM 5
      1. Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months
9. Management
   1. See Specific causes
   2. See Female Sexual Dysfunction
   3. See Chronic Pelvic Pain Management
   4. See Vaginismus
   5. See Vulvodynia
   6. See Atrophic Vaginitis
   7. See Vaginal Dryness
10. Complications
    1. Sexual Dysfunction
    2. Relationship Distress
    3. Decreased quality of life
    4. Mood Disorder (Major Depression, Anxiety Disorder)
11. References
    1. Heim (2001) Am Fam Physician 63(8):1535-44 [PubMed]
    2. Hill (2021) Am Fam Physician 103(10):597-604 [PubMed]
    3. Seehusen (2014) Am Fam Physician 90(7): 465-70 [PubMed]