Dyspareunia

Question 1

Define dyspareunia

Answer 1

Pain during intercourse. Dyspareunia is only used if there is no primary nonorganic sexual dysfunction e.g. vaginismus, otherwise it should be categorised under the pathological condition

Question 2

DSM definition

Answer 2

Genito-Pelvic Pain/Penetration Disorder, persistent or recurrent difficulties with one or more of the following:
• Vaginal penetration during intercourse
• Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
• Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
• Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration

Question 3

Risk factors

Answer 3

Sexual inexperience

Peri/post menopausal

Question 4

Physiological causes

Answer 4

Manipulation – infection, injury, irritation, lesions, hypersensitivity

Introitus (pain on entry) - Episiotomy/circumcision, recurrent infection, herpes, allergies, Bartholin’s cyst, interstitial cystitis, urethritis, vaginal atrophy, menopause, post-radiotherapy, poor lubrication, insufficient sexual arousal, effects of a substance (drug/medication), penis size

Mid-deep vaginal pain - Endometriosis, congenital shortened vagina, fixed uterine retroversion, pelvic tumours, surgical adhesions, irritable bowel, constipation

Question 5

Psychological causes

Answer 5

Previous experience of pain

Previous sexual abuse

Poor sexual education

Poor understanding of anatomy and physiology

Insufficient relaxation

Painful or unpleasant
gynaecological examination

Question 6

Relationship causes

Answer 6

Poor technique of partner

Speed / timing of partner

Fear of intimacy

Anger / resentment towards partner

Question 7

Presentation

Answer 7

Can be superficial or deep. If there is tightening of the vaginal muscles this is suggestive of vaginismus

Question 8

Ix

Answer 8

Physical examination

Swabs - STIs

MSU

Question 9

Differentials

Answer 9

• Hymenal ring
• Bartholins gland cyst
• Vulvodynia
• Vulvitis
• Lichen sclerosis
• Uterine contractions
• Vaginitis

Question 10

Tx

Answer 10

1. Examination by a specialist doctor
2. Repeat bloods
3. Couples therapy
4. Personal Sexual Growth program (both)
5. Sensate focus to (re)start and (re)learn sexual contact with the addition of pain and how it can be managed in a sexual context
6. Relaxation and meditation

Question 11

What is involved in couples therapy?

Answer 11

a. Depression
b. Negative communication patterns
c. Job/ disability
d. What is needed and wanted in the relationship