Dyspareunia Disease

BASICS

DESCRIPTION

Recurrent and persistent genital pain associated with sexual activity, in either the male or female. Dyspareunia may be due to organic, emotional or psychogenic causes.

Primary: Present throughout one's sexual history
Secondary: Arising from some specific event or condition, e.g., menopause, drugs
Superficial: Difficulty or pain at or near the introitus or vaginal barrel associated with penetration
Deep: Pain after penetration located at the cervix or lower abdominal area
Complete: Present under all circumstances
Situational: Occurring selectively with specific situations
System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA:
- Most women who are sexually active will experience dyspareunia at some time in their lives. Approximately 15% (4-40%) of adult women will have dyspareunia on a few occasions during a year. About 1-2% of women will have painful intercourse on a more than occasional basis.
- Male prevalence unknown
Predominant age: All ages
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Varying degrees of pelvic/genital pressure, aching, tearing and/or burning

CAUSES

Disorders of vaginal outlet
- Hymenal ring abnormalities
- Postmenopausal atrophy
- Decreased lubrication
- Episiotomy scars
- Vulvar vestibulitis/vulvodynia
- Infections
- Trauma
- Adhesions
- Clitoral irritation
- Vulvar papillomatosis
Disorders of vagina
- Infections
- Masses or tumors
- Decreased lubrication
- Pelvic relaxation resulting in rectocele, uterine prolapse or cystocele
- Inflammatory or allergic response to foreign substance
- Abnormality of vault due to surgery or radiation
- Congenital malformations
Disorders of pelvic structures
- Pelvic inflammatory disease
- Endometriosis
- Malignant or benign tumors of the uterus
- Ovarian pathology
- Pelvic adhesions
- Prior pelvic fracture
- Levator ani myalgia
- Pelvic venous congestion
Disorders of the gastrointestinal tract
- Inflammatory bowel disease
- Crohn's disease
- Diverticulitis
- Constipation
- Hemorrhoids
- Fistulas
Disorders of the urinary tract
- Interstitial cystitis
- Ureteral or vesical lesions
Male
- Genital muscle spasm
- Infection and irritation of penile skin
- Cancer of penis
- Penile anatomy disorders
- Prostate infections and enlargement
- Infection of seminal vesicles
- Testicular disease
- Torsion of spermatic cord
- Musculoskeletal disorders of pelvis and lower back
- Urethritis
Psychologic disorders
- Fear
- Anxiety
- Phobic reactions
- Conversion reactions
- Hostility towards partner
- Psychological trauma

RISK FACTORS

Diabetes
Estrogen deficiency
Alcohol/marijuana consumption
Menopause
Medroxyprogesterone use
Stress
Fatigue or overwork

DIAGNOSIS

LABORATORY

Gonorrhea culture
Wet mount
Chlamydia culture
Herpes culture
Urine analysis
Urine culture
Pap smear to assess estrogen status

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Dependent on etiology

SPECIAL TESTS

N/A

IMAGING

Voiding cystourethrogram if urinary tract involvement
Gastrointestinal contrast studies if GI symptoms

DIAGNOSTIC PROCEDURES

Colposcopy and biopsy if vaginal/vulvar lesions
Laparoscopy if complex deep penetration pain
Cystoscopy if urinary tract involvement
Sigmoidoscopy if GI involvement

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

The first step in treatment is to educate the patient and partner as to the nature of the problem and reassure them the problem can be solved
Organic causes can generally be identified during the initial evaluation and specific treatment initiated
Once organic causes have been ruled out, individual and/or couple behavioral therapy should be initiated
Behavioral therapy
- Designed to systemically desensitize to intercourse through a series of interventions over a period of weeks
- Interventions range from muscle relaxation and mutual body massage to sexual fantasies and erotic massage, with the ultimate goal of intercourse and sexual responsiveness
Individual therapy
- Indicated to help the patient deal with intrapsychic issues and assess the role of the partner
Couple therapy
- Indicated to help resolve interpersonal problems
- May involve short-term structured intervention or sexual counseling
- Referral for long-term therapy may be necessary

SURGICAL MEASURES

Should be avoided
Surgical vestibulectomy can be considered when conservative measures fail with vulvar-vestibulitis

ACTIVITY

Routine

DIET

Regular; a high-fiber diet may help if constipation is the cause

PATIENT EDUCATION

Patient education models, information on sexual arousal techniques, Kegel exercise information (Instructions for Patients, Griffith, H.W., W.B. Saunders Co., Philadelphia; Our Bodies, Ourselves for the New Century: A book by and for women, Boston Women's Health Collective, Simon & Schuster, New York)

FOLLOW UP

PREVENTION/AVOIDANCE

Avoidance of alcohol and tobacco products

POSSIBLE COMPLICATIONS

N/A

EXPECTED COURSE AND PROGNOSIS

The majority of cases will respond to treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

Vaginismus

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: The incidence increases dramatically in the postmenopausal woman who is not receiving HRT primarily because of vaginal atrophy. Over half of all sexually active women will report dyspareunia.
Others: N/A

PREGNANCY

Pregnancy is a potent influence on sexuality; dyspareunia is common
Episiotomies have been associated with dyspareunia. Mediolateral episiotomies have greater incidence when compared to midline.

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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