II. Definition

  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
  5. Psychosocial factors
    1. Younger age
    2. Lower educational status (less than college degree)
    3. Emotional stressors
    4. Decrease in household income >20%

V. History

  1. See Chronic Pelvic Pain
  2. Proceed through history stepwise from least intrusive to most detailed
    1. Medical and surgical history
    2. Gynecologic and obstetric history
    3. Sexual history
    4. Sexually Transmitted Infection history
    5. Physical abuse or sexual abuse
    6. Symptoms with sexual activity
      1. Distinguish entry Dyspareunia from deep Dyspareunia
      2. Distinguish primary (from the first episode of sexual activity) and secondary Dyspareunia (later onset)
    7. Negative impacts of Dyspareunia
      1. Interpersonal relationships
      2. Self esteem

VI. Exam

VII. Causes

  1. Entry or localized pain at the vaginal introitus
    1. Vulvodynia or Vulvar Vestibulitis
      1. Vulvar burning or irritation
    2. Vulvar Dermatitis (Vulvar Dermatoses)
      1. Papulosquamous Vulvar Dermatoses (e.g. Vulvar Lichen Sclerosus et atrophicus, Vulvar Lichen Planus, Contact Dermatitis, Psoriasis)
      2. Bullous Vulvar Dermatoses (e.g. Erythema Multiforme, Bullous Pemphigoid, Pemphigus)
      3. Genital Ulcers
      4. Systemic disease (e.g. Behcet's Disease, Systemic Lupus Erythematosus, Reiter's Syndrome)
    3. Peri-vaginal infection
      1. Vaginitis
      2. Human Papillomavirus
      3. Herpes Simplex Virus
    4. Atrophic Vaginitis or impaired vaginal lubrication
      1. See Vaginal Dryness
    5. Vaginismus
      1. Introitus muscles spasm on entry
    6. Urethral disorders or cystitis
      1. Urethritis symptoms
    7. Postpartum Dyspareunia
      1. Present after first deliveries in 41% at 3 months and 22% at 6 months
      2. Due to sclerotic healing (e.g. perineal Stretching and Lacerations, operative vaginal deliveries)
      3. Exacerbated by hypoestrogenic states (e.g. Breast Feeding) and psychosocial factors leading to decreased arousal
      4. Treat Vaginal Dryness as a first-line therapy
      5. Revision perineoplasty has been used in severe, refractory cases
  2. Pain on deep vaginal penetration
    1. Chronic Cervicitis
    2. Endometriosis
    3. Uterine Fibroids
    4. Pelvic adhesions
    5. Pelvic congestion
    6. Retroverted Uterus
    7. Interstitial Cystitis
    8. Pelvic infection
      1. Endometritis
      2. Pelvic Inflammatory Disease

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

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Ontology: Dyspareunia (female) (C0013394)

Concepts Disease or Syndrome (T047)
ICD9 625.0
ICD10 N94.1
SnomedCT 81712001, 139073009
English Pain fem genit on intercourse, Painful sexual act of female, dyspareunia, dyspareunia (diagnosis), Dyspareunia (female), coitalgia, Dyspareunia, Female coitalgia, Pain in female genitalia on intercourse, Pain in female genitalia on intercourse (finding), coitus; pain, female, dyspareunia; female, pain; coitus, female, Pain;sexual intercourse;F, painful intercourse (female)
German Dyspareunie
Korean 성교통
Dutch coïtus; pijn, vrouw, dyspareunie; vrouw, pijn; coïtus, vrouw, Dyspareunie
Spanish coitalgia en la mujer, coito doloroso femenino (hallazgo), coito doloroso femenino, dispareunia femenina