Dyspareunia

Question 1

What is Dyspareunia?

Answer 1

Pain during intercourse.

Question 2

What is the aetiology of Dyspareunia?

Answer 2

Organic or psychological.

· Superficial:

o Infection (candida, tricomonas), atrophy (menopause) vaginismus (involuntary contraction of muscles preventing penetration), vulval vestibulitis (chronic inflammation of vestibule with pain and erythema) dermatological (lichen sclerosis, lichen planus) scarring (episiotomy) congenitally narrowm hymenal ring, vaginal stenosis, vaginal septm sexual inexperience.

· Deep:

o PID, endometriosis, chronic interstitial cystitis, fixed uterine retroversion, pelvic congestion syndrome, pelvic adhesions, ovarian cyst.

Question 3

What is the epidemiology of Dyspareunia?

Answer 3

Difficult to estimate, 50% occasional, 25% regularly

Question 4

What is the history/ exam of Dyspareunia?

Answer 4

History
Superficial or deep pain during and after intercourse,

Examination
Abdomen: depend on deep causes i.e. masses.

Vulvovaginal inspection: erythema, candida, signs of superficial lesions,

Vaginal: uterine position, mobiliry, masses, retrovaginal and uterosacral nodules.

Question 5

What Ix do you do for Dyspareunia?

Answer 5

MCS: HVS, endocervical and chlamydia screen.

Palvic USS (deep), diangostic laparoscopy if suspcet endometriosis.

Question 6

What is the Mx of Dyspareunia?

Answer 6

Superficial:

· Infection: antibiotics

· Dermatoses: treat cause, topical steroids

· Atrophy: topical steroids or HRT

· Anatomica: surgery

· Vvsyndrome: steroids, physio, amytryptiline low dose, vestibulectomy.

· Vaginismus: dilator therapy and counselling.

Deep: adhesionolysis, ovarian cystectoy, tx endometriosis, interstitial cystitis etc.

Question 7

What are the complications/ prognosis of Dyspareunia?

Answer 7

Psychosexual issues, relaitonship, organic cause cmx. PGx depends on cause.