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dyspareunia
Difficult or painful sexual intercourse.
Etiology:
1) superficial dyspareunia
a) vaginismus/ infectious vaginitis
b) vulvar vestibulitis
c) inadequate lubrication
d) atrophic vaginitis
e) urethritis
f) lichen sclerosus [1]
2) deep dyspareunia
a) endometriosis
b) pelvic adhesions
c) pelvic inflammatory disease (fever, vaginal dicharge, pelvic pain)
d) interstitial cystitis (urinary frequency, urinary urgency, nocturia)
e) ovarian mass
f) arthritis
Epidemiology:
1) under-reported
2) common problem
3) occurs at least occasionally in 33% of women
4) occurs frequently or all of the time in 10% of women
Clinical manifestations:
1) decreased frequency of sexual activity
2) adverse effects on intimate relationships
3) pelvic examination in [2] described as atrophic vaginitis &/or vaginal atrophy
- pale vaginal mucosa with visible veins
- mildly stenotic introitus
- diminished vaginal caliber & length
Differential diagnosis:
1) sexual abuse
2) dysfunctional relationship
Management:
1) specific measures for specific etiology
2) general measures
a) lubrication (Replens, Maxilube) for women with adequate vaginal caliper & length without vulvar or vaginaltenderness
b) vaginal estrogen for atrophic vaginitis/vaginal atrophy
3) vaginal caliper & length can be improved with use a graduated dilators after vaginal estrogen treatment to rejuvenate vaginal mucosa
4) ospemifene is an oral estrogen agonist/antgonist FDA-approved for treatment of dyspareunia [2]
- contraindicated in patients with increased risk for thromboembolism, history of breast cancer, ovarian cancer, uterine cancer
5) prasterone (Intrarosa), once a day vaginal insert for treatment of dyspareunia in postmenopausal women FDA-approved [3]
6) vaginoplasty more likely to cause harm than provide benefit except in case of vaginal stricutre due to prior vaginal reconstructive surgery of pelvic radiation [2]
Related
endometriosis
ovarian cancer
pelvic inflammatory disease (PID)
vaginitis
General
sign/symptom
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17.
American College of Physicians, Philadelphia 1998, 2015
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Brooks M
FDA OKs Prasterone for Dyspareunia in Postmenopausal Women.
Medscape. Nov 17, 2016
http://www.medscape.com/viewarticle/872022
- FDA News Release. November 17, 2016
FDA approves Intrarosa for postmenopausal women experiencing
pain during sex.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm529641.htm
Component-of
genito-pelvic pain/penetration disorde