Dyspareunia

Dyspareunia is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

5-Minute Clinical Consult (5MCC) app and website powered by Unbound Medicine helps you diagnose and manage 900+ medical conditions. Exclusive bonus features include Diagnosaurus DDx, 200 pediatrics topics, and medical news feeds. Explore these free sample topics:

5-Minute Clinical Consult

-- The first section of this topic is shown below --

Basics

Description

  • Recurrent and persistent genital pain associated with sexual activity, which is not exclusively due to lack of lubrication or vaginismus, and is associated with distress or interpersonal difficulty
  • May be the result of organic, emotional, or psychogenic causes
    • Primary: present throughout one’s sexual history
      • Potential relationship exists between primary dyspareunia and vaginismus, low libido, and arousal disorders.
    • Secondary: arising from some specific event or condition (e.g., menopause, drugs)
    • Superficial: 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

Epidemiology

  • Predominant age: all ages
  • Predominant sex: female > male

Incidence
>50% of all sexually active women will report dyspareunia at some time.

Geriatric Considerations
Incidence increases dramatically in postmenopausal women primarily because of vaginal atrophy.

Prevalence

Most sexually active women will experience dyspareunia at some time in their lives.

  • ~15% (4–40%) of adult women will have dyspareunia on a few occasions during a year.
  • ~1–2% of women will have painful intercourse on a more-than-occasional basis.
  • Male prevalence is ~1%.

Etiology and Pathophysiology

  • Disorders of vaginal outlet
    • Adhesions
    • Condyloma
    • Clitoral irritation
    • Episiotomy scars
    • Fissures
    • Hymenal ring abnormalities
    • Inadequate lubrication
    • Infections
    • Lichen planus
    • Lichen sclerosus
    • Postmenopausal atrophy
    • Psoriasis
    • Trauma
    • Vulvar papillomatosis
    • Vulvar vestibulitis/vulvodynia
  • Disorders of vagina
    • Abnormality of vault owing to surgery or radiation
    • Congenital malformations
    • Inadequate lubrication
    • Infections
    • Inflammatory or allergic response to foreign substance
    • Masses or tumors
    • Pelvic relaxation resulting in rectocele, uterine prolapse, or cystocele
  • Disorders of pelvic structures
    • Endometriosis
    • Levator ani myalgia/spasm
    • Malignant or benign tumors of the uterus
    • Ovarian pathology
    • Pelvic adhesions
    • Pelvic inflammatory disease (PID)
    • Pelvic venous congestion
    • Prior pelvic fracture
    • Uterine fibroids
  • Disorders of the GI tract
    • Constipation
    • Crohn disease
    • Diverticular disease
    • Fistulas
    • Hemorrhoids
    • Inflammatory bowel disease
  • Disorders of the urinary tract
    • Interstitial cystitis
    • Ureteral or vesical lesions
    • Urethritis
  • Chronic disease
    • Behçet syndrome
    • Diabetes
    • Sjögren syndrome
  • Male
    • Cancer of penis
    • Genital muscle spasm
    • Infection or irritation of penile skin
    • Infection of seminal vesicles
    • Lichen sclerosus
    • Musculoskeletal disorders of pelvis and lower back
    • Penile anatomy disorders
    • Phimosis
    • Prostate infections and enlargement
    • Testicular disease
    • Torsion of spermatic cord
    • Urethritis
  • Psychological disorders
    • Anxiety
    • Conversion reactions
    • Depression
    • Fear
    • Hostility toward partner
    • Phobic reactions
    • Psychological trauma

Risk Factors

  • Fatigue
  • Stress
  • Depression
  • Diabetes
  • Estrogen deficiency
    • Menopause
    • Lactation
  • Previous PID
  • Vaginal surgery
  • Alcohol/marijuana consumption
  • Medication side effects (antihistamines, tamoxifen, bromocriptine, low-estrogen oral contraceptives, SSRIs, depo-medroxyprogesterone, desipramine)
Pregnancy Considerations
  • Pregnancy has a potent influence on sexuality; dyspareunia is common in late pregnancy and postpartum.
    • Breastfeeding, perineal pain, fatigue, and stress can be risk factors in postpartum period.
  • Episiotomies do not have a protective effect.
    • Women who experience delivery interventions including episiotomy are at greater risk than women who deliver over an intact perineum or have an unsutured tear.

Commonly Associated Conditions

Vaginismus

-- To view the remaining sections of this topic, please or purchase a subscription --