DYSPAREUNIA
Ask the following questions:
- 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.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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