Painful sex Flashcards
What are the causes of dyspareunia?
Superficial: infection e.g. candidiasis, dryness e.g. atrophic vaginitis, skin condition e.g. lichen sclerosis, vulvodynia
Midway: vaginimus
Deep: pelvic pathology e.g. endometriosis, ovarian cyst, adhesions
What is the definition of vulvodynia?
Vulva discomfort occurring in the absence of relevant physical findings
Not caused by infection, inflammation, neoplasia or neurologic disorder
What is the pathophysiology of vulvodynia?
Triggered by something e.g. Candida, laser, trauma –> tissue changes (inflammatory) –> nerve fibre proliferation or damage –> pain feedback loop –> central sensitisation
What are the Sx of vulvodynia?
Burning pain
Non painful stimuli become painful (allodynia)
How should you test for vulvodynia?
Q Tip test (cotton bud) - very painful when you touch the outside of their vagina with a cotton bud
What is the management of vulvodynia
Simple skin care - avoid irritants and stimulants
Medications - TCAs (neuropathic pain), anticonvulsant
Encourage couples to pursue other ways of being close and nurturing while the cause of dyspareunia is being treated
What are the Sx and signs of lichen sclerosis?
Itching
Soreness
Splitting of the skin at the posterior fourchette
Dyspareunia
Fragile and white ‘parchment paper’ appearance of skin in anogenital area
Loss of vulval anatomy
What is the management for lichen sclerosis?
Good skin care
Strong steroid ointment
Monitor for vulval cancer
What is the definition of vaginismus?
The persistent or recurrent difficulty of the woman to allow vaginal entry of the penis, a finger or any other object despite wanting to do so
Due to involuntary contractions/ tightness of pelvic floor muscles
What are the causes of vaginismus?
Primary: fear/ anxiety of pain, neverbeen able to relax and comfortably insert anything vaginally - e.g. tampon or speculum
Secondary: Onset of PFM tightness post candidiasis, HPV treatment, unaroused intercourse, PTSD e.g. rape
What are the Sx and signs of vaginismus?
‘When I try to have sex we seem to hit a brick wall’
Not being able to use tampons
Affected women often avoid intercourse and anticipate/ fear pain
Associated muscle tension of neck and back
Vaginal itself is almost always normal
What is the management for vaginismus?
Physiotherapy - PFMT
What are causes of post-coital bleeding?
Cervical polyps Cervical ectropion Cervical cancer Endometrial cancer Cervicitis
