Dyspareunia

Question 1

What key history would you obtain from a patient who complains of dyspareunia?

Answer 1

Duration
Timing
Associated symptoms (vaginal discharge, rash, painful menses, GI symptoms, hot flashes)
Adequacy of lubrication
Libido
Sexual history
History of sexual trauma or domestic violence
History of endometriosis, PID, or prior abdominal/pelvic surgeries

Question 2

What key physical exams would you perform on a patient who complains of dyspareunia?

Answer 2

Vital signs
Abdominal exam
Complete pelvic exam

Question 3

54 yo F complains of painful intercourse. Her last menstrual period was nine months ago. She has hot flashes. Differentials?

Answer 3

Atrophic vaginitis
Endometriosis
Cervicitis
Depression
Domestic abuse

Question 4

54 yo F complains of painful intercourse. Her last menstrual period was nine months ago. She has hot flashes. Differentials: atrophic vaginitis, endometriosis, cervicitis, depression, domestic abuse. Workup?

Answer 4

Pelvic exam
Wet mount
KOH prep
Cervical cultures
U/S - pelvis

Question 5

37 yo F presents with dyspareunia, inability to conceive and dysmenorrhea. Differentials?

Answer 5

Endometriosis
Cervicitis
Vaginismus
Vulvodynia
PID
Depression
Domestic violence

Question 6

37 yo F presents with dyspareunia, inability to conceive and dysmenorrhea. Differentials: endometriosis, cervicitis, vaginismus, vulvodynia, PID, depresison, domestic violence. Workup?

Answer 6

Pelvic exam
Wet mount
KOH prep
Cervical culture
U/S - pelvis
Laparoscopy