Dyspareunia history and symptoms

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History

History and physical exam:

• Ask aboutPain Characteristics:
  
  • Timing, duration, quality, location
    
• Ask about associated vulvovaginal symptoms:
  • Itching
  • Burning
  • Irritation
  • Abnormal discharge
• Musculoskeletal history:
  • Pelvic floor surgery, trauma, obstetrics
• bowel and bladder history:
  • Constipation, diarrhea, urgency, frequency
    
• Obtain sexual history:
  • Frequency, desire, arousal, satisfaction, relationship
• Obtain psychological history:
  • Mood disorder, anxiety, depression
    
• Inquire about any history of abuse:
  • Sexual, physical, neglect
    
• Physical exam:
  • Look for any abnormal areas of erythema or edema, white patches,vulvular scarring,ulcers on external genitalia
• Vagina and cervix examination
  • Look for any erythema, erosions,atrophy,discharge
    
• Evaluation of external musculoskeletal:
  • complete lower back, abdomen, and pelvic examination
    
• external visual and sensory examination
  
  • internal single digit palpation of the pelvic floor
    
  • bimanual examination for evaluation of:
    
    • ❑ uterus, cul-de-sac, and adnexal regions
  • the internal vaginal tissue, cervix
• Work up:
  
  • Vaginal secretions:
    • vaginal pH and saline wet mount and 10% KOH microscopy
• If history is suggestive, perform:
  • NAAT test for gonorrhea, chlamidia,trichomonas
  • herpes simplex virus (HSV) culture, HSV-1 and HSV-2 type specific IgG antibodies
  • rapid plasma reagent (RPR)
• vulvar or vaginal biopsy for dermatological problems, malignancy
• Urine analysis,culture for urological problems
• blood count
• Glucose
• Hormones:
  ❑prolactin, TSH, FSH,LH, Testosterone
• Ultrasound of plevis
• Laprascopy

More detail evaluations for systemic disorders

Dyspareunia Microchapters
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Overview
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Epidemiology and Demographics
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Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

Symptoms

When pain occurs, the woman experiencing dyspareunia may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the phallus is painful. Even after the original source of pain (a healing episiotomy, for example) has disappeared, a woman may feel pain simply because she expects pain. In brief, dyspareunia can be classified by the time elapsed since the woman first felt it:

• During the first 2 weeks or so, dyspareunia caused by phallus insertion or movement of the phallus in the vagina or by deep penetration is often due to disease or injury deep within the pelvis.
• After the first 2 weeks or so, the original cause of dyspareunia may still exist with the woman still experiencing the resultant pain. Or it may have disappeared, but the woman has anticipatory pain associated with a dry, tight vagina.