dyspareunia n.
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Dyspareunia

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  1. Dyspareunia Dr Felicia Molokoane

  2. Introduction • Sexual dysfunction manifested by genital pain experienced just before, during or after sexual intercourse. • More common in women. • It can affect the quality of life • Associated symptoms • CPP, dysmenorrhoea, tampon discomfort, urinary urgency, IBS

  3. Epidemiology Incidence is unknown

  4. Aetiology Causes are classified depending on onset, frequency, and anatomical site

  5. Onset • Primary • Onset with the first sexual experience • Causes are often psychosocial • →sexual abuse in childhood • →feeling of guilt or shame towards sex • →fear of painful first intercourse • SECONDARY • The patient had a previous normal sexual function • The causes are usually physical

  6. Physical causes of dyspareunia Congenital disorders Imperforate hymen Vaginal septum Abdominopelvic disorders CPP Pelvic endometriosis Vaginal disorders Vaginitis Vaginismus Prolapse GIT Chronic constipation Diverticular disease IBS

  7. Frequency Persistent Conditional Symptoms occur with all partners in all situations Possible causes include physical or psychosocial factors Symptoms occur with certain position, type of stimulation or a specific partner Causes include physical or psychosocial factors

  8. Anatomical site Superficial or insertional Deep Sharp, stinging or burning pain at or near the vaginal introitus Commonly found in patients with vulvodynia, vaginismus, or vestibulodynia Pain felt within the pelvis with deep penetration, for example, penile thrusting within the vagina Causes include, pelvic tumours, infections, endometriosis

  9. Conditions commonly associated with deep dyspareunia • CPP • Any pelvic pain that last for more than 6 months • Endometriosis • Common symptoms of endometriosis include pelvic pain, dysmenorrhoea, dyspareunia, abnormal bleeding and infertility • Majority of women are asymptomatic • Chronic PID • Can present with pelvic pain or dyspareunia • Pelvic adhesions may form as a result of inflammatory processes in the pelvis

  10. Conditions commonly associated with superficial dyspareunia • Vulvodynia • Unpleasant burning sensation or painful response to stimulus that is not normally painful such as sexual intercourse or touch of cotton wool swab. • Physical causes include of vulvodynia include lichen sclerosis, vulval infections and hypoestrogenic states. • Vaginismus • Physical response of involuntary spasm of the introital muscles to psychological stress. • Insertion of the fingers, penis or tampoon are common triggers of the spasm • Perineal trauma following childbirth

  11. Examination

  12. Investigation • Vaginal swabs • Pelvic ultrasound • Diagnostic laparoscopy

  13. Management • Treatment depends on the cause • Psychosexual factors, refer for psychosexual assessment

  14. Medical treatment • General measures • Allow sufficient time for arousal and lubrication • Avoid some sexual position • Watery based or silicone based lubricants • Systemic or local estrogens

  15. Surgical treatment • Rarely needed • Endometriosis→ Excision of the lesion