Dyspareunia overview
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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]Roghayeh Marandi
Overview
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.
historical perspective
Classification
It may be classified into two types in women: superficial, which occurs in or around the vaginal entrance, and is characterized by initial discomfort in initial or attempted penetration of the vaginal introitus. Deep dyspareunia is a pain that occurs with deep vaginal penetration. which resulting from pelvic thrusting during intercourse. Causes are divided into three groups according to Onset, Frequency as well. Based on the onset, dyspareunia can be divided into two groups based on the onset in women: Primary (onset with first sexual experience) Often has psychological causes, such as sexual abuse in childhood, feeling of guilt or shame toward sex, or fear of intercourse or painful first intercourse, and secondary dyspareunia that its beginning is after a previous sexual activity that was not painful. Dyspareunia can be Persistent, which occurs in all situations, possibly due to physical or psychological factors, or conditional dyspareunia that occurs in certain situations. Abdomino-pelvic disorders such as endometriosis, imperforate hymen, vaginal septum, or organic vulvodynia due to infection, lichen sclerosis, or vestibulitis, vaginal infections, prolapse, trauma, or vaginal dryness can cause dyspareunia. It can also be due to gastrointestinal disorders such as chronic constipation, diverticular diseases, inflammatory bowel disease/proctitis. Scarring due to previous pelvic surgery, episiotomy, and perineorraphy, or urological causes such as cystitis, interstitial cystitis, or urethritis can cause dyspareunia as well. Male dyspareunia is divided into broad categories of underlying causes ranging from anatomic anomalies to psychosocial problems. Male dyspareunia is related to the following anatomical structures: 1) prepuce, 2) glans penis, 3) penile shaft, 4) testicles, and 5) urethra and prostate gland. Another classification system defines four broad categories: Isolated painful ejaculation, Chronic prostatitis/chronic pelvic pain, Medical causes, psychological causes.
Pathophysiology
Dyspareunia is caused by medical causes, psychological problems, and pathophysiology of dyspareunia vary based on the underlying causes. For example, estrogen deficiency causes atrophic vaginitis or ectopic uterine tissues in endometriosis causes dyspareunia. Psychological problems can cause dyspareunia.
Causes
Common causes of dyspareunia include localized infectious and congenital disorders of the vulva, vagina, and perianal regions. Additional causes include systemic conditions and diseases.
Differential diagnosis
Endometriosis, Vulvodynia, Vaginismus, Atrophic vaginitis, and difficulty with lubrication, Vulvar vestibulitis, Vaginal dryness,Infections(Human papillomavirus, Herpes simplex virus, Pelvic inflammatory disease, Chronic salpingitis,uterine fibroids, pelvic adhesions,Adnexal pathology,Retroverted uterus, pelvic relaxation, Chronic cervicitis, Pelvic congestion, Genitourinary( Urethral, Cystitis, Interstitial cystitis, Psychological problems such as anxiety, depression in women and Erectile dysfunction in the male, Inadequate sexual stimuli,Lichen sclerosis,Pelvic inflammatory disease, Premature ejaculation in the male,Isolauted painful ejaculation, chronic pelvic syndrome, Genitourinary problems such as urethritis, and psychological problems in men.
Epidemiology and dermographics
The prevalence of dyspareunia is unknown of the overall population. Nonetheless, it is estimated that 15% of women in North America notify recurrent pain during intercourse.
Risk factors
Risk factors vary base on the underlying cause of dyspareunia. for example, history of Physical abuse, Sexual abuse are risk factors of vaginismus.
Natural history,complications and prognosis
It is more common in women. rarely can be seen in men. Dyspareunia can have a negative impact on a woman's mental and physical health, body image, relationships with partners, and efforts to conceive. It can affect the quality of life. It can lead to, or be associated with, other female sexual dysfunction disorders, such as decreased libido, decreased arousal, and anorgasmia. Prognosis Depending on the cause of dyspareunia, the prognosis may vary.
Diagnosis
History and Symptoms
Patients with dyapreunia may have a positive history of genitourinary infection, sexual abuse, or psychological problems. The most common symptoms of dyspareunia is pain just before, during, or after intercourse.
Physical Examination
Physical examination findings of patients with dyspareunia vary based on the underlying cause.
Laboratory Findings
Different laboratory findings can be seen in patient with dyspareunia based on the underlying cause.
X-Ray Findings
There are no x-ray findings associated with dyspareunia.
echocardioraphy and ultrasound
There are no echocardiography findings associated with dyspareunia. Ultrasound may be helpful in the diagnosis of the cause of dyspareunia.
CT-Scan Findings
MRI
other imaging findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery