II. Epidemiology
- Dyspareunia present after first deliveries in 41% at 3 months and 22% at 6 months
III. Symptoms
- Dyspareunia following Vaginal Delivery
- Exacerbated by Vaginal Dryness (treat with Vaginal Lubricant as first line therapy)
- Hypoestrogenic states (e.g. Breast Feeding)
- Psychosocial factors leading to decreased arousal
IV. Differential Diagnosis
- See Dyspareunia
- See Female Sexual Dysfunction
- Vulvodynia (Pelvic Floor Muscle Tenderness, Pelvic Floor Dysfunction)
- Infection (e.g. Vaginitis)
V. Management
- See Dyspareunia
- Exclude other causes (see above)
- Vaginal Lubricant (first-line)
- Revision perineoplasty has been used in severe, refractory cases
- Painful perineal scarring
- Granulation tissue
- Laceration breakdown
- Significant anatomic distortion
- Poorly healed perineal Lacerations
VI. Prognosis
- Prolonged course due to sclerotic healing (e.g. perineal Stretching and Lacerations, operative vaginal deliveries)