Dyspareunia

Dyspareunia

·        = Pain with sex

·        Causes:

o  Superficial pain: vulvitis (eg HSV), introital shrinkage (atrophy, scarring), vaginismus 

o   Vaginal pain: post-menopausal atrophy, medication (eg antihistamines), arousal phase dysfunction 

o  Deep-pain: pelvic disease (endometriosis, adenomyosis), shortened vaginal vault post-hysterectomy, retroverted uterus 

·        May be cycle of anticipation of pain ® tense muscles and lack lubrication ® further pain

·        Treatment if no aetiology uncovered:

o  Lubricants

o  Oestrogen replacement

o  Position modification

o  Counselling

·        Vaginismus: involuntary spasm of the levator ani muscle making penetration difficult.  May be related 

·        to prior trauma/abuse. Pain-vaginismus-pain cycle develops. Treatment: behaviour modification, progressive vaginal dilatation