Dyspareunia

Dyspareunia: Excerpt from Professional Guide to Diseases (Eighth Edition)

Dyspareunia is genital pain associated with intercourse. It may be mild, or it may be severe enough to affect enjoyment of intercourse. Dyspareunia is commonly associated with physical problems; less commonly, with a psychological disorder. The prognosis is good if the underlying disorder can be treated successfully.

Causes

Physical causes of dyspareunia include an intact hymen; deformities or lesions of the introitus or vagina; marked retroversion of the uterus; genital, rectal, or pelvic scar tissue; acute or chronic infections of the genitourinary tract; and disorders of the surrounding viscera (including residual effects of pelvic inflammatory disease or disease of the adnexal and broad ligaments).

Among the many other possible physical causes are:

❑ endometriosis

❑ benign and malignant growths and tumors

❑ insufficient lubrication

❑ radiation to the area

❑ allergic reactions to diaphragms, condoms, or other contraceptives.

Psychological causes include fear of pain or of injury during intercourse, recollection of a previous painful experience, guilty feelings about sex, fear of pregnancy or of injury to the fetus during pregnancy, anxiety caused by a new sexual partner or technique, and mental or physical fatigue. Men and women can suffer pain in the pelvic area during or soon after sexual intercourse.

Signs and symptoms

Dyspareunia produces discomfort, ranging from mild aches to severe pain before, during, or after intercourse. It may also be associated with vaginal itching or burning.

Diagnosis

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.

Treatment

Treatment of physical causes may include creams and water-soluble gels for inadequate lubrication, appropriate medications for infections, excision of hymenal scars, and gentle stretching of painful scars at the vaginal opening. The patient may be advised to change her coital position to reduce pain on deep penetration.

Methods of treating psychologically based dyspareunia vary with the particular patient. Sensate focus exercises deemphasize intercourse itself and teach appropriate foreplay techniques. Education about contraception methods can reduce fear of pregnancy; education about sexual activity during pregnancy can relieve fear of harming the fetus.

Special considerations

❑ Provide instruction concerning anatomy and physiology of the reproductive system, contraception, and the human sexual response cycle.

❑ When appropriate, provide advice and information on drugs that may affect the patient sexually and on lubricating gels and creams.

❑ Listen to the patient’s complaints of sex-related pain, and maintain a sympathetic, nonjudgmental attitude toward her, which will encourage her to express her feelings without embarrassment.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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