Diagnosis of Dyspareunia
Dyspareunia Diagnosis: Book Excerpts
Diagnostic Tests for Dyspareunia: Online Medical Books
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DYSPAREUNIA:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Does the history indicate that the difficulty is on penetration? Difficulties on penetration usually point to a vulval or vaginal origin for the problem. In that case, bartholinitis, vulvitis, vulval dystrophy, cystitis, urethritis, and urethral caruncle should be suspected.
- Is the urinalysis abnormal? An abnormal urinalysis may indicate cystitis or a bladder calculus.
- Are there abnormalities on rectal examination? Hemorrhoids, anal fissures, and impacted feces may cause dyspareunia.
- Is the pelvic examination totally normal? If this is true, one would consider functional dyspareunia, or it may be that the patient does not have dyspareunia at all and simply has no sexual desire or dislikes the sexual act.
DIAGNOSTIC WORKUP
It is extremely important to look for evidence of sexual abuse both on history and physical examination before undertaking an expensive workup. Routine studies include a CBC, sedimentation rate, urinalysis, urine culture and sensitivity, and vaginal smear and culture. A Pap smear should also be done. If pregnancy is suspected, a pregnancy test should be done. If there is a pelvic mass, pelvic ultrasound may be helpful. A referral to a gynecologist is usually made before ordering this study, however. If vulval dystrophy is suspected, a vaginal biopsy may be useful. If the vaginal examination is normal, perhaps a psychiatrist should be consulted.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Dyspareunia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Definitions
–Sexual pain disorder: Persistent or recurrent genital pain of nonorganic cause associated with sexual stimulation, thus causing personal stress; subcategories include dyspareunia and vaginismus
–Superficial dyspareunia: Pain or dysfunction felt upon initial penetration
–Deep dyspareunia: Pain or dysfunction felt deep within the pelvis during intercourse
–Vaginismus: Painful involuntary spasm of the vagina, preventing intercourse
–Vulvar vestibulitis: A chronic and persistent clinical syndrome characterized by severe pain with vestibular touch or attempted vaginal entry, tenderness in response to pressure within the vulvar vestibule, and physical findings confined to various degrees of vestibular erythema
–Vulvodynia: Chronic vulvar discomfort
(e.g. burning, stinging, irritation, rawness)
-
Neurologic etiologies: Nerve damage or infection, dysesthetic (essential) vulvodynia
-
Gynecologic etiologies: Gynecologic tumors (e.g., vulvar, cervical, uterine, ovarian, or rectal cancer; fibroids), Bartholin's gland inflammation
-
GI: Constipation, irritable bowel syndrome, colitis, diverticulitis, GI tumors (in pelvis)
-
Urinary: Interstitial cystitis, urethritis, urethral diverticulum
-
Infectious: Endometritis, vaginitis, PID, salpingitis, vulvovaginitis, herpes genitalis, post-herpetic neuralgia, Bartholin's abscess
-
Dermatologic etiologies: Vaginal atrophy, lichen sclerosis, Behçet syndrome, contact dermatitis
-
Musculoskeletal: Pelvic floor myopathy, fibromyalgia, levator ani myalgia, dysfunctional vaginismus
-
Endocrine: Estrogen deficiency, endometriosis
-
Psychiatric: Female sexual dysfunction(s)
-
Iatrogenic: Surgical (e.g., pelvic adhesions, episiotomy, strictures), pharmacologic (drying soaps or agents, topical medications, OCPs)
-
Trauma: Vaginal lacerations or ecchymoses
-
Primary pain disorder
-
Severely retroverted uterus
-
Imperforate hymen
Workup and Diagnosis
- History and physical examination with pelvic and rectal exams
–Timing: Onset (e.g., upon entry, after intercourse), duration, persistence after intercourse, prior occurrence(s)
–Associations: Symptoms may occur with all vaginal or vulvar contact, with intercourse only, with exams only, with masturbation, or with memories or recollections of prior occurrences or traumatic experiences
–Alleviating and aggregating factors during intercourse
–Qualifiers: Burning, sharp, dull, aching, throbbing,
stabbing
–Old medical records may be of crucial importance
–Include complete psychiatric history and exam
-
Cervical and/or vulvar cultures and microscopic evaluation of normal saline and potassium hydroxide wet mounts should be done
-
Imaging studies may be indicated, including pelvic and/or abdominal ultrasound and/or CT scan
-
Management of psychiatric causes is particularly challenging and requires specific and specialized therapy
-
Consider gynecology and/or psychiatry consult
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
DYSPAREUNIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to this diagnosis includes an examination of both male and female genital organs and counseling by an understanding physician if these examinations are negative.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Dyspareunia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Physical examination and laboratory tests help determine the underlying disorder. Diagnosis also depends on a detailed sexual history and the answers to such questions as: When does the pain occur? Does it occur with certain positions or techniques or at certain times during the sexual response cycle? Where does the pain occur? What’s its quality, frequency, and duration? What factors relieve or aggravate it?
When the disorder causes marked distress or interpersonal difficulty, it may fulfill the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dyspareunia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient to describe the pain. Does it occur with attempted penetration or deep thrusting? How long does it last? Is the pain intermittent or does it always accompany intercourse? Ask whether changing coital position or using a vaginal lubricant relieves the pain.
Next, ask about a history of pelvic, vaginal, or urinary tract infection. Does the patient have signs and symptoms of a current infection? Have her describe any discharge. Also, ask about malaise, headache, fatigue, abdominal or back pain, nausea and vomiting, and diarrhea or constipation.
Obtain a sexual and menstrual history. Determine whether dyspareunia is related to the patient’s menstrual cycle. Are her cycles regular? Ask about dysmenorrhea and metrorrhagia. Has the patient had a baby? If so, did she have an episiotomy? Note whether she’s breast-feeding. Ask about previous abortion, sexual abuse, or pelvic surgery. Also, find out what contraceptive method the patient uses. Does her partner use condoms? Does he or could he have a latex allergy? Then try to determine her attitude toward sexual intimacy. Does she feel tense during coitus? Is she satisfied with the length of foreplay? Does she usually achieve orgasm? Ask about a history of rape, incest, or sexual abuse as a child.
Next, perform a physical examination, starting with vital signs. Palpate the abdomen for tenderness, pain, or masses and for inguinal lymphadenopathy. Finally, inspect the genitalia for lesions and vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
DYSPAREUNIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to this diagnosis includes an examination of both male and
female genital organs and counseling by an understanding physician if these
examinations are negative.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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