1. Dyspareunia
Dr Felicia Molokoane

2. Introduction
Sexual dysfunction manifested by genital pain experienced just before, during or after sexual intercourse.
More common in women.
It can affect the quality of life
Associated symptoms
CPP, dysmenorrhoea, tampon discomfort, urinary urgency, IBS

3. Epidemiology
Incidence is unknown

4. Aetiology
Causes are classified depending on onset, frequency, and anatomical site

5. Onset Primary SECONDARY Onset with the first sexual experience
Causes are often psychosocial
→sexual abuse in childhood
→feeling of guilt or shame towards sex
→fear of painful first intercourse
SECONDARY
The patient had a previous normal sexual function
The causes are usually physical

6. Physical causes of dyspareunia
Congenital disorders
Imperforate hymen
Vaginal septum
Abdominopelvic disorders
CPP
Pelvic endometriosis
Vaginal disorders
Vaginitis
Vaginismus
Prolapse
GIT
Chronic constipation
Diverticular disease
IBS

7. Frequency Persistent Conditional
Symptoms occur with all partners in all situations
Possible causes include physical or psychosocial factors
Symptoms occur with certain position, type of stimulation or a specific partner
Causes include physical or psychosocial factors

8. Superficial or insertional
Anatomical site
Superficial or insertional
Deep
Sharp, stinging or burning pain at or near the vaginal introitus
Commonly found in patients with vulvodynia, vaginismus, or vestibulodynia
Pain felt within the pelvis with deep penetration, for example, penile thrusting within the vagina
Causes include, pelvic tumours, infections, endometriosis

9. Conditions commonly associated with deep dyspareunia
CPP
Any pelvic pain that last for more than 6 months
Endometriosis
Common symptoms of endometriosis include pelvic pain, dysmenorrhoea, dyspareunia, abnormal bleeding and infertility
Majority of women are asymptomatic
Chronic PID
Can present with pelvic pain or dyspareunia
Pelvic adhesions may form as a result of inflammatory processes in the pelvis

10. Conditions commonly associated with superficial dyspareunia
Vulvodynia
Unpleasant burning sensation or painful response to stimulus that is not normally painful such as sexual intercourse or touch of cotton wool swab.
Physical causes include of vulvodynia include lichen sclerosis, vulval infections and hypoestrogenic states.
Vaginismus
Physical response of involuntary spasm of the introital muscles to psychological stress.
Insertion of the fingers, penis or tampoon are common triggers of the spasm
Perineal trauma following childbirth

11. Examination

12. Investigation
Vaginal swabs
Pelvic ultrasound
Diagnostic laparoscopy

13. Management Treatment depends on the cause
Psychosexual factors, refer for psychosexual assessment

14. Medical treatment General measures Systemic or local estrogens
Allow sufficient time for arousal and lubrication
Avoid some sexual position
Watery based or silicone based lubricants
Systemic or local estrogens

15. Surgical treatment
Rarely needed
Endometriosis→ Excision of the lesion