II. Definitions

  1. Dyspareunia
    1. Recurrent or persistent pain on vaginal penetration

III. Epidemiology

  1. Prevalence: 10-20% of women in the United States
  2. Age: More common on younger ages

IV. Risk Factors: Contributing Psychological Factors (and complications of Dyspareunia)

  1. Female Sexual Dysfunction
    1. Impaired sexual desire (libido)
    2. Decreased sexual arousal
    3. Anorgasmia
  2. Mood Disorder
    1. Major Depression
    2. Anxiety
  3. Sexual abuse history
  4. Comorbidity
    1. Decreased overall health status
    2. Urinary tract symptoms
    3. Fibromyalgia
    4. Irritable Bowel Syndrome
  5. Gynecologic history
    1. Postpartum Status
    2. Perimenopausal or PostMenopausal
    3. Vacuum Assisted Delivery or Forceps Assisted Delivery
    4. Pelvic Floor Surgery
    5. Recent Breast Feeding
  6. Psychosocial factors
    1. Younger age
    2. Lower educational status (less than college degree)
    3. White race
    4. Emotional stressors
    5. Decrease in household income >20%

V. History

  1. See Chronic Pelvic Pain
  2. Proceed through history stepwise from least intrusive to most detailed
  3. Medical and surgical history
  4. Gynecologic and obstetric history
  5. Sexual History
  6. Sexually Transmitted Infection history
  7. Physical abuse or sexual abuse including Intimate Partner Violence
  8. Symptoms with sexual activity
    1. Location, intensity and duration of pain
    2. Associated bowel, Bladder and musculoskeletal symptoms
    3. Painful sexual activities
    4. Distinguish entry Dyspareunia from deep Dyspareunia
    5. Distinguish primary (from the first episode of sexual activity) and secondary Dyspareunia (later onset)
  9. Negative impacts of Dyspareunia
    1. Interpersonal relationships
    2. Self esteem

VIII. Diagnosis

  1. DSM 5 now combines Dyspareunia with Vaginismus
  2. Dyspareunia diagnosis (and Vaginismus diagnosis) per DSM 5
    1. Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months

X. Complications

  1. Sexual Dysfunction
  2. Relationship Distress
  3. Decreased quality of life
  4. Mood Disorder (Major Depression, Anxiety Disorder)

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