1. October 2014 Dyspareunia Presented by: Hilary Liddell Date: Wednesday 22 nd October 2014

2. October 2014 Dyspareunia Distress Dissatisfaction

3. October 2014 1.Superficial – Introital 2.Deep - Pelvic

4. October 2014 History Young – Peripartum – Older Superficial Onset Candidiasis – Treatment Discharge Oestrogen Deficiency Tampon Insertion Relationship Difficulties Sexual abuse Deep – Other Pelvic Pain

5. Take a look

6. October 2014 Examination  Demeanor - Hyperaesthesia  Vulval lesions – fissures  Vaginal discharge – STD swabs  Vaginismus  Swab tenderness 4 & 8  Uterine + P.O.D. tenderness  Masses

7. October 2014 Deep Endometriosis –Retroversion –P.O.D. disease Adenomyosis P.I.D. Adnexal mass

8. October 2014 Superficial Vestibulodynia Skin type Antibiotics –Candidiasis Topical Antifungals Hyperaesthesia – Chronic Pain Syndrome Sexual Dysfunction

9. October 2014 Sexual Problems Lack of Arousal Lack of Protective Physiological Response Avoidance I/C Increased local trauma / pain

10. October 2014 Local Trauma (Candidiasis) The Vicious Cycle

11. October 2014 Treatment - Multifactorial Skin care Avoidance soap, topical antifungals Cotton Not shaving Pinetarsol, other soap substitutes Lubricants Oral antifungals Vaginal dilators Sexual Counselling Physiotherapy

12. October 2014 Woodruffs Repair

13. Thank you