Dyspareunia resident survival guide

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Dyspareunia Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
in Female
in Male
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roghayeh Marandi

Synonyms and keywords: Dyspareunia management guide, pain, sexual activity, counseling

Overview

Dyspareunia is recurrent or persistent pain with sexual activity that causes marked distress or interpersonal conflict. It can affect men, but more common among women. It can due to psychological factors, physical factors, or combined factors among both, males and females. It may be classified into two types among women that include superficial and deep dyspareunia. Causes are divided into three groups according to onset and frequency. Onset can be divided primary or secondary. Primary causes often include psychological issues. Based on the frequency, dyspareunia can be persistent, and possibly due to physical or psychological factors, or conditional dyspareunia. Abdomino-pelvic disorders such as endometriosis, imperforate hymen, vaginal septum, vulvar and vaginal infections, lichen sclerosis, prolapse, trauma, or vaginal dryness can cause dyspareunia. It may also be caused by gastrointestinal disorders and scarring from previous pelvic surgery. Male dyspareunia is divided into broad categories based on the underlying causes, and ranges from anatomic anomalies to psychosocial problems. Male dyspareunia can be divided into four broad categories: Isolated painful ejaculation, Chronic prostatitis/chronic pelvic pain, medical causes, and psychological causes. The management is based on identifying the underlying cause. Treatment ranges from psychosexual therapy, medications or surgery. Multimodal sex therapy, consisting of individual and couples therapy and other interventions such as cognitive–behavior techniques, is an important part of the multidisciplinary approach to these disorders.

Causes

Common Causes among females[1][2][3][4][5][6]

Causes of dyspareunia in males[7]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of dyspareunia.[8][9][10][11][12]

Dyspareunia in Female

 
 
 
 
 
 
 
Assessment of dyspareunia in female
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and physical exam
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Genital alterations
 
 
Systemic disorders/Comorbid conditions/Medications
 
Psychological problems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Dyspareunia in Male

 
 
 
 
 
 
 
Assessment of dyspareunia in male
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and physical exam
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Genital alterations
 
 
Comorbid conditions/Medications
 
Psychological problems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of dyspareunia.[2][13]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment of dyspareunia:
❑ It depends on the underlying cause and subsequent therapy (see table below for details)
❑ Educating patients about pelvic anatomy, physiology, and lifestyle modifications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Treatment
 
 
 
 
Psychosexual Therapy:
❑ Oral tricyclic antidepressants
❑ Referral for couple sexual counseling or therapy to explore non-penetrating pleasuring techniques (as appropriate)
Cognitive behavioral therapy
 
 
Surgical Treatment
 
 
 
 
 
 
 

Do's

Don'ts

References

  1. https://www.acog.org/patient-resources/faqs/gynecologic-problems/when-sex-is-painful
  2. Jump up to: 2.0 2.1 Sorensen J, Bautista KE, Lamvu G, Feranec J (March 2018). "Evaluation and Treatment of Female Sexual Pain: A Clinical Review". Cureus. 10 (3): e2379. doi:10.7759/cureus.2379. PMC 5969816. PMID 29805948.
  3. Yong PJ, Williams C, Yosef A, Wong F, Bedaiwy MA, Lisonkova S, Allaire C (September 2017). "Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia". Sex Med. 5 (3): e184–e195. doi:10.1016/j.esxm.2017.07.001. PMC 5562494. PMID 28778678.
  4. Thomas HM, Bryce CL, Ness RB, Hess R (February 2011). "Dyspareunia is associated with decreased frequency of intercourse in the menopausal transition". Menopause. 18 (2): 152–7. doi:10.1097/gme.0b013e3181eeb774. PMC 3026887. PMID 20962696.
  5. Kumar K, Robertson D (June 2017). "Superficial dyspareunia". CMAJ. 189 (24): E836. doi:10.1503/cmaj.161337. PMC 5478410. PMID 28630360.
  6. Shum LK, Bedaiwy MA, Allaire C, Williams C, Noga H, Albert A, Lisonkova S, Yong PJ (September 2018). "Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis". Sex Med. 6 (3): 224–233. doi:10.1016/j.esxm.2018.04.006. PMC 6085224. PMID 29801714.
  7. Krassioukov A, Elliott S (2017). "Neural Control and Physiology of Sexual Function: Effect of Spinal Cord Injury". Top Spinal Cord Inj Rehabil. 23 (1): 1–10. doi:10.1310/sci2301-1. PMC 5340504. PMID 29339872.
  8. Meana M, Binik YM, Khalife S, Cohen DR (October 1997). "Biopsychosocial profile of women with dyspareunia". Obstet Gynecol. 90 (4 Pt 1): 583–9. doi:10.1016/s0029-7844(98)80136-1. PMID 9380320.
  9. Mulherin DM, Sheeran TP, Kumararatne DS, Speculand B, Luesley D, Situnayake RD (September 1997). "Sjögren's syndrome in women presenting with chronic dyspareunia". Br J Obstet Gynaecol. 104 (9): 1019–23. doi:10.1111/j.1471-0528.1997.tb12060.x. PMID 9307528.
  10. Bhadauria S, Moser DK, Clements PJ, Singh RR, Lachenbruch PA, Pitkin RM, Weiner SR (February 1995). "Genital tract abnormalities and female sexual function impairment in systemic sclerosis". Am. J. Obstet. Gynecol. 172 (2 Pt 1): 580–7. doi:10.1016/0002-9378(95)90576-6. PMID 7856689.
  11. Clayton AH, Croft HA, Handiwala L (March 2014). "Antidepressants and sexual dysfunction: mechanisms and clinical implications". Postgrad Med. 126 (2): 91–9. doi:10.3810/pgm.2014.03.2744. PMID 24685972.
  12. Luzzi GA, Law LA (November 2006). "The male sexual pain syndromes". Int J STD AIDS. 17 (11): 720–6, quiz 726. doi:10.1258/095646206778691220. PMID 17062172.
  13. https://doi.org/10.18192/uojm.v7i2.2198
  14. Slowinski J (2001). "Multimodal sex therapy for the treatment of vulvodynia: a clinician's view". J Sex Marital Ther. 27 (5): 607–13. doi:10.1080/713846805. PMID 11554226.