Dyspareunia overview: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 4: Line 4:
==Overview==
==Overview==
Dyspareunia is painful [[sexual intercourse]], due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed [[vaginismus]].
Dyspareunia is painful [[sexual intercourse]], due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed [[vaginismus]].
==historical perspective==
==Historical Perspective==
There is limited information about the historical perspective of [[dyspareunia]].
There is limited information about the historical perspective of [[dyspareunia]].


Line 10: Line 10:
It may be classified into two types in women: [[superficial]], which occurs in or around the vaginal entrance, and is characterized by initial discomfort in initial or attempted penetration of the vaginal introitus. Deep dyspareunia is a pain that occurs with deep [[vaginal]] penetration. which resulting from pelvic thrusting during intercourse. Causes are divided into three groups according to Onset, Frequency as well. Based on the onset, [[dyspareunia]] can be divided into two groups based on the onset in women: Primary (onset with first sexual experience) Often has psychological causes, such as sexual abuse in childhood, feeling of guilt or shame toward sex, or fear of intercourse or painful first intercourse, and secondary dyspareunia that its beginning is after a previous sexual activity that was not painful. Dyspareunia can be Persistent, which occurs in all situations, possibly due to physical or psychological factors, or conditional dyspareunia that occurs in certain situations. Abdomino-pelvic disorders such as [[endometriosis]], [[imperforate hymen]], [[vaginal septum]], or organic [[vulvodynia]] due to infection, [[Lichen sclerosus|lichen sclerosis]], or vestibulitis, vaginal infections, [[prolapse]], [[trauma]], or vaginal dryness can cause [[dyspareunia]]. It can also be due to [[gastrointestinal disorders]] such as [[chronic constipation]], diverticular diseases, [[inflammatory bowel disease]]/[[proctitis]]. Scarring due to previous pelvic surgery, [[episiotomy]], and perineorraphy, or urological causes such as [[cystitis]], [[interstitial cystitis]], or [[urethritis]] can cause [[dyspareunia]] as well. Male [[dyspareunia]] is divided into broad categories of underlying causes ranging from [[anatomic]] anomalies to [[psychosocial]] problems. Male dyspareunia is related to the following anatomical structures: 1) [[prepuce]], 2) [[glans penis]], 3) penile shaft, 4) [[testicles]], and 5) [[urethra]] and [[prostate gland]]. Another classification system defines four broad categories: Isolated painful [[ejaculation]], [[Chronic prostatitis/chronic pelvic pain syndrome|Chronic prostatitis/chronic pelvic pain]], [[Medical]] causes, [[psychological]] causes.
It may be classified into two types in women: [[superficial]], which occurs in or around the vaginal entrance, and is characterized by initial discomfort in initial or attempted penetration of the vaginal introitus. Deep dyspareunia is a pain that occurs with deep [[vaginal]] penetration. which resulting from pelvic thrusting during intercourse. Causes are divided into three groups according to Onset, Frequency as well. Based on the onset, [[dyspareunia]] can be divided into two groups based on the onset in women: Primary (onset with first sexual experience) Often has psychological causes, such as sexual abuse in childhood, feeling of guilt or shame toward sex, or fear of intercourse or painful first intercourse, and secondary dyspareunia that its beginning is after a previous sexual activity that was not painful. Dyspareunia can be Persistent, which occurs in all situations, possibly due to physical or psychological factors, or conditional dyspareunia that occurs in certain situations. Abdomino-pelvic disorders such as [[endometriosis]], [[imperforate hymen]], [[vaginal septum]], or organic [[vulvodynia]] due to infection, [[Lichen sclerosus|lichen sclerosis]], or vestibulitis, vaginal infections, [[prolapse]], [[trauma]], or vaginal dryness can cause [[dyspareunia]]. It can also be due to [[gastrointestinal disorders]] such as [[chronic constipation]], diverticular diseases, [[inflammatory bowel disease]]/[[proctitis]]. Scarring due to previous pelvic surgery, [[episiotomy]], and perineorraphy, or urological causes such as [[cystitis]], [[interstitial cystitis]], or [[urethritis]] can cause [[dyspareunia]] as well. Male [[dyspareunia]] is divided into broad categories of underlying causes ranging from [[anatomic]] anomalies to [[psychosocial]] problems. Male dyspareunia is related to the following anatomical structures: 1) [[prepuce]], 2) [[glans penis]], 3) penile shaft, 4) [[testicles]], and 5) [[urethra]] and [[prostate gland]]. Another classification system defines four broad categories: Isolated painful [[ejaculation]], [[Chronic prostatitis/chronic pelvic pain syndrome|Chronic prostatitis/chronic pelvic pain]], [[Medical]] causes, [[psychological]] causes.
==Pathophysiology==
==Pathophysiology==
[[Dyspareunia]]  is caused by  [[medical causes]], [[psychological]] problems, and pathophysiology can be considered as multifactorial, multisystemic or complex. dyspareunia vary based on the underlying causes . For example, estrogen deficiency causes atrophic vaginitis or ectopic uterine tissues in endometriosis causes dyspareunia.
[[Dyspareunia]]  is caused by  [[medical causes]], [[psychological]] problems, and pathophysiology can be considered as multifactorial, multisystem or complex. dyspareunia vary based on the underlying causes . For example, estrogen deficiency causes atrophic vaginitis or ectopic uterine tissues in endometriosis causes dyspareunia.


==Causes==
==Causes==
Common causes of dyspareunia include localized [[infectious]] and [[congenital]] disorders of the [[vulva]], [[vagina]], and [[perianal]] regions. Additional causes include systemic conditions and diseases.
Common causes of dyspareunia include localized [[infectious]] and [[congenital]] disorders of the [[vulva]], [[vagina]], and [[perianal]] regions. Additional causes include systemic conditions and diseases.


==Differential diagnosis==
==Differential Diagnosis==
[[Endometriosis]], [[Vulvodynia]], [[Vaginismus]], [[Atrophic vaginitis]], and difficulty with lubrication, Vulvar vestibulitis, [[Vaginal dryness]],Infections(Human papillomavirus, Herpes simplex virus, Pelvic inflammatory disease, Chronic salpingitis,uterine fibroids, pelvic adhesions,Adnexal pathology,Retroverted uterus, pelvic relaxation, Chronic cervicitis, Pelvic congestion, Genitourinary( Urethral, Cystitis, Interstitial cystitis, Psychological problems such as anxiety, depression in women and [[Erectile dysfunction]] in the male, Inadequate sexual stimuli,[[Lichen sclerosis]],[[Pelvic inflammatory disease]], Premature ejaculation in the male,Isolauted painful ejaculation, chronic pelvic syndrome, Genitourinary problems such as urethritis, and psychological problems in men.
[[Endometriosis]], [[Vulvodynia]], [[Vaginismus]], [[Atrophic vaginitis]], and difficulty with lubrication, Vulvar vestibulitis, [[Vaginal dryness]],Infections(Human papillomavirus, Herpes simplex virus, Pelvic inflammatory disease, Chronic salpingitis, uterine fibroids, pelvic adhesions, Adnexal pathology, retoverted uterus, pelvic relaxation, Chronic cervicitis, Pelvic congestion, Genitourinary( Urethral, Cystitis, Interstitial cystitis, Psychological problems such as anxiety, depression in women and [[Erectile dysfunction]] in the male, Inadequate sexual stimuli,[[Lichen sclerosis]],[[Pelvic inflammatory disease]], Premature ejaculation in the male, isolated painful ejaculation, chronic pelvic syndrome, Genitourinary problems such as urethritis, and psychological problems in men.


==Epidemiology and dermographics==
==Epidemiology and Dermographics==
The prevalence of dyspareunia is unknown of the overall population. Nonetheless, it is estimated that 15% of women in North America notify recurrent pain during intercourse.
The prevalence of dyspareunia is unknown of the overall population. Nonetheless, it is estimated that 15% of women in North America notify recurrent pain during intercourse.


Line 24: Line 24:
Risk factors vary base on the underlying cause of dyspareunia. for example, history of [[Physical abuse]], [[Sexual abuse]] are risk factors of vaginismus.
Risk factors vary base on the underlying cause of dyspareunia. for example, history of [[Physical abuse]], [[Sexual abuse]] are risk factors of vaginismus.


==Natural history,complications and prognosis==
==Natural history, Complications and Prognosis==
It is more common in women. rarely can be seen in men. [[Dyspareunia]] can have a negative impact on a woman's [[mental]] and physical health, [[body image]], relationships with partners, and efforts to conceive.
It is more common in women. rarely can be seen in men. [[Dyspareunia]] can have a negative impact on a woman's [[mental]] and physical health, [[body image]], relationships with partners, and efforts to conceive.
It can affect the quality of life. It can lead to, or be associated with, other female [[sexual dysfunction]] disorders, such as [[decreased libido]], decreased [[arousal]], and [[anorgasmia]]. Prognosis Depending on the cause of [[dyspareunia]], the prognosis may vary.
It can affect the quality of life. It can lead to, or be associated with, other female [[sexual dysfunction]] disorders, such as [[decreased libido]], decreased [[arousal]], and [[anorgasmia]]. Prognosis Depending on the cause of [[dyspareunia]], the prognosis may vary.
Line 30: Line 30:
==Diagnosis==
==Diagnosis==
===Diagnostic criteria===
===Diagnostic criteria===
Diagnosis Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) dyspareunia and vaginismus were typically classified as distinct sexual pain disorders.This new classification unifies vaginismus and dyspareunia into one category called “genito-pelvic pain/penetration disorder” due to the clinical difficulties to distinguishing these condition.
Diagnosis Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) dyspareunia and vaginismus were typically classified as distinct sexual pain disorders. This new classification unifies vaginismus and dyspareunia into one category called “genito-pelvic pain/penetration disorder” due to the clinical difficulties to distinguishing these condition.


===History and Symptoms===
===History and Symptoms===
Line 38: Line 38:
===Laboratory Findings===
===Laboratory Findings===
Different laboratory findings can be seen in patient with dyspareunia based on the underlying cause.
Different laboratory findings can be seen in patient with dyspareunia based on the underlying cause.
===X-Ray Findings'''===
===X-Ray===
There are no x-ray findings associated with dyspareunia.
There are no x-ray findings associated with dyspareunia.
===echocardioraphy and ultrasound===
===Echocardiography and Ultrasound===
There are no echocardiography findings associated with dyspareunia. Ultrasound may be helpful in the diagnosis of the underlying cause of dyspareunia.  
There are no echocardiography findings associated with dyspareunia. Ultrasound may be helpful in the diagnosis of the underlying cause of dyspareunia.  
===CT-Scan Findings===
===CT Scan ===
Ct-Scan may be helpful in the diagnosis of the underlying cause of dyspareunia such as pelvic tumors.
Ct-Scan may be helpful in the diagnosis of the underlying cause of dyspareunia such as pelvic tumors.
===MRI===
===MRI===
There are no MRI findings associated with [[dyspareunia]].
There are no MRI findings associated with [[dyspareunia]].


===other imaging findings===
===Other Imaging Findings===
There are no other imaging findings associated with [[dyspareunia]].
There are no other imaging findings associated with [[dyspareunia]].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
[[Laprascopy]] may be helpful in the diagnosis of [[dyspareunia]].
Laparoscopy may be helpful in the diagnosis of [[dyspareunia]].


==Treatment==
==Treatment==
Line 59: Line 59:
[[Surgery]] is performed as a last resort when all conservative and medical management options have failed or when [[surgery]] is indicated in situations such as Endometriosis to remove the topic uterine tissue.
[[Surgery]] is performed as a last resort when all conservative and medical management options have failed or when [[surgery]] is indicated in situations such as Endometriosis to remove the topic uterine tissue.
===Primary prevention===
===Primary prevention===
There are no established measures for the primary prevention of [[dyspareunia]], but can prevent of some of the causes of dyspareunia, for example:prevent sexually transmitted diseases (STDs) by using condoms or other barriers,get proper routine medical care,Use proper hygiene, wait at least six weeks before resuming sexual intercourse after childbirth.
There are no established measures for the primary prevention of [[dyspareunia]], but can prevent of some of the causes of dyspareunia, for example: prevent sexually transmitted diseases (STDs) by using condoms or other barriers, get proper routine medical care, use proper hygiene, wait at least six weeks before resuming sexual intercourse after childbirth.


===Secondary prevention===
===Secondary prevention===
Effective measures for the secondary prevention of [[dyspareunia]] depends on the underlying cause of it, for example: using a water-soluble lubricant when vaginal dryness is an issue,encouraging natural vaginal lubrication with enough time for foreplay and stimulation, doing exercise to relieve muscular thightness in [[vaginismus]].
Effective measures for the secondary prevention of [[dyspareunia]] depends on the underlying cause of it, for example: using a water-soluble lubricant when vaginal dryness is an issue, encouraging natural vaginal lubrication with enough time for foreplay and stimulation, doing exercise to relieve muscular tightness in [[vaginismus]].


===Future or investigational therapies===
<br />
 
==References==
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Sexual and gender identity disorders]]
[[Category:Sexual and gender identity disorders]]

Revision as of 17:46, 21 September 2020

Dyspareunia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Dyspareunia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Dyspareunia overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Dyspareunia overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Dyspareunia overview

CDC on Dyspareunia overview

Dyspareunia overview in the news

Blogs on Dyspareunia overview

Directions to Hospitals Treating Dyspareunia

Risk calculators and risk factors for Dyspareunia overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]Roghayeh Marandi

Overview

Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.

Historical Perspective

There is limited information about the historical perspective of dyspareunia.

Classification

It may be classified into two types in women: superficial, which occurs in or around the vaginal entrance, and is characterized by initial discomfort in initial or attempted penetration of the vaginal introitus. Deep dyspareunia is a pain that occurs with deep vaginal penetration. which resulting from pelvic thrusting during intercourse. Causes are divided into three groups according to Onset, Frequency as well. Based on the onset, dyspareunia can be divided into two groups based on the onset in women: Primary (onset with first sexual experience) Often has psychological causes, such as sexual abuse in childhood, feeling of guilt or shame toward sex, or fear of intercourse or painful first intercourse, and secondary dyspareunia that its beginning is after a previous sexual activity that was not painful. Dyspareunia can be Persistent, which occurs in all situations, possibly due to physical or psychological factors, or conditional dyspareunia that occurs in certain situations. Abdomino-pelvic disorders such as endometriosis, imperforate hymen, vaginal septum, or organic vulvodynia due to infection, lichen sclerosis, or vestibulitis, vaginal infections, prolapse, trauma, or vaginal dryness can cause dyspareunia. It can also be due to gastrointestinal disorders such as chronic constipation, diverticular diseases, inflammatory bowel disease/proctitis. Scarring due to previous pelvic surgery, episiotomy, and perineorraphy, or urological causes such as cystitis, interstitial cystitis, or urethritis can cause dyspareunia as well. Male dyspareunia is divided into broad categories of underlying causes ranging from anatomic anomalies to psychosocial problems. Male dyspareunia is related to the following anatomical structures: 1) prepuce, 2) glans penis, 3) penile shaft, 4) testicles, and 5) urethra and prostate gland. Another classification system defines four broad categories: Isolated painful ejaculation, Chronic prostatitis/chronic pelvic pain, Medical causes, psychological causes.

Pathophysiology

Dyspareunia is caused by medical causes, psychological problems, and pathophysiology can be considered as multifactorial, multisystem or complex. dyspareunia vary based on the underlying causes . For example, estrogen deficiency causes atrophic vaginitis or ectopic uterine tissues in endometriosis causes dyspareunia.

Causes

Common causes of dyspareunia include localized infectious and congenital disorders of the vulva, vagina, and perianal regions. Additional causes include systemic conditions and diseases.

Differential Diagnosis

Endometriosis, Vulvodynia, Vaginismus, Atrophic vaginitis, and difficulty with lubrication, Vulvar vestibulitis, Vaginal dryness,Infections(Human papillomavirus, Herpes simplex virus, Pelvic inflammatory disease, Chronic salpingitis, uterine fibroids, pelvic adhesions, Adnexal pathology, retoverted uterus, pelvic relaxation, Chronic cervicitis, Pelvic congestion, Genitourinary( Urethral, Cystitis, Interstitial cystitis, Psychological problems such as anxiety, depression in women and Erectile dysfunction in the male, Inadequate sexual stimuli,Lichen sclerosis,Pelvic inflammatory disease, Premature ejaculation in the male, isolated painful ejaculation, chronic pelvic syndrome, Genitourinary problems such as urethritis, and psychological problems in men.

Epidemiology and Dermographics

The prevalence of dyspareunia is unknown of the overall population. Nonetheless, it is estimated that 15% of women in North America notify recurrent pain during intercourse.

Risk factors

Risk factors vary base on the underlying cause of dyspareunia. for example, history of Physical abuse, Sexual abuse are risk factors of vaginismus.

Natural history, Complications and Prognosis

It is more common in women. rarely can be seen in men. Dyspareunia can have a negative impact on a woman's mental and physical health, body image, relationships with partners, and efforts to conceive. It can affect the quality of life. It can lead to, or be associated with, other female sexual dysfunction disorders, such as decreased libido, decreased arousal, and anorgasmia. Prognosis Depending on the cause of dyspareunia, the prognosis may vary.

Diagnosis

Diagnostic criteria

Diagnosis Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) dyspareunia and vaginismus were typically classified as distinct sexual pain disorders. This new classification unifies vaginismus and dyspareunia into one category called “genito-pelvic pain/penetration disorder” due to the clinical difficulties to distinguishing these condition.

History and Symptoms

Patients with dyapreunia may have a positive history of genitourinary infection, sexual abuse, or psychological problems. The most common symptoms of dyspareunia is pain just before, during, or after intercourse.

Physical Examination

Physical examination findings of patients with dyspareunia vary based on the underlying cause.

Laboratory Findings

Different laboratory findings can be seen in patient with dyspareunia based on the underlying cause.

X-Ray

There are no x-ray findings associated with dyspareunia.

Echocardiography and Ultrasound

There are no echocardiography findings associated with dyspareunia. Ultrasound may be helpful in the diagnosis of the underlying cause of dyspareunia.

CT Scan

Ct-Scan may be helpful in the diagnosis of the underlying cause of dyspareunia such as pelvic tumors.

MRI

There are no MRI findings associated with dyspareunia.

Other Imaging Findings

There are no other imaging findings associated with dyspareunia.

Other Diagnostic Studies

Laparoscopy may be helpful in the diagnosis of dyspareunia.

Treatment

Medical Therapy

It depends on the underlying cause and subsequent therapy(see table below for details). Educate patients about pelvic anatomy, physiology, and lifestyle modification.

Surgery

Surgery is performed as a last resort when all conservative and medical management options have failed or when surgery is indicated in situations such as Endometriosis to remove the topic uterine tissue.

Primary prevention

There are no established measures for the primary prevention of dyspareunia, but can prevent of some of the causes of dyspareunia, for example: prevent sexually transmitted diseases (STDs) by using condoms or other barriers, get proper routine medical care, use proper hygiene, wait at least six weeks before resuming sexual intercourse after childbirth.

Secondary prevention

Effective measures for the secondary prevention of dyspareunia depends on the underlying cause of it, for example: using a water-soluble lubricant when vaginal dryness is an issue, encouraging natural vaginal lubrication with enough time for foreplay and stimulation, doing exercise to relieve muscular tightness in vaginismus.