Dyspareunia Flashcards
Types of dyspareunia
Superficial vs Deep
Causes of superficial dyspareunia
Physiological - inadequate lubrication Vaginitis esp chronic candidiasis Vulvar dermatosis Postnatal perineal scarring Vulvovaginal atrophy Vulvular vestibular syndrome Incompletely ruptured hymen Urethritis Vaginismus
Causes of deep dyspareunia
Endometriosis PID Pelvic adhesions Ovarian and uterine tumours Retroverted uterus Postnatal
Tx of dyspareunia
Tx organic causes
advice about use of lubricant
Oestrogen creams
Lignocaine gel.
Cause of atrophic vaginitis
Low oestrogen levels states e.g. breastfeeding, progesterone only pills. menopause
Pathogenesis of atrophic vaginitis
Reduced oestrogen = thinned endometrium and increase vaginal pH
Symptoms of atrophic vaginitis
reduced lubrication vaginal discharge - Clear or blood stained, watery consistency, no odour, dryness, burning vulvar pruritic Superficial dyspareunia Breast feeding Progesterone only pills Increase chance of superimposed infection
Signs of atrophic vaginitis
atrophic epithelium - pale, smooth and shiny
Inflammation - patchy erythema, petechiae and increase friability
Introital stenosis or decreased vaginal depth = pain on examination with speculum
Loss of rugae
Complications of atrophic vaginitis
Predisposed to UTI and vaginal infection
How to diagnosis atrophic vaginitis
- exclude other causes
Tx of atrophic vaginitis
Topical oestrogen
Systemic oestrogen therapy
DDX atrophic vaginitis
Contact irrigation or reaction
Infection - candidiasis, bacterial vaginosis, trichomoniasis
