Dyspareunia: Difference between revisions
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Level of dyspareunia pain (0-10) | Level of dyspareunia pain (0-10) | ||
== Management / Interventions == | == Management / Interventions == | ||
'''Physiotherapy''' | '''Physiotherapy''' | ||
Physiotherapists can address factors contributing to dyspareunia. | Physiotherapists can address factors contributing to dyspareunia with the following tools and techniques. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Contributing factor | !Contributing factor | ||
!Tool/Technique | !Tool/Technique | ||
|- | |- | ||
| | |Lack of awareness of pelvic floor muscles | ||
|Assess the patient's ability to connect with their pelvic floor muscles through their ability to correctly contract and ''relax'' their pelvic floor muscles | |Assess the patient's ability to connect with their pelvic floor muscles through their ability to correctly contract and ''relax'' their pelvic floor muscles. If the patient is unable to correctly recruit these muscles, this might be a good place to begin therapy. | ||
|- | |- | ||
|Hypertension of pelvic floor muscles | |Hypertension of pelvic floor muscles | ||
|Teaching relaxation techniques for the pelvic floor muscles: | |Teaching relaxation techniques for the pelvic floor muscles: | ||
# Yoga positions, such as | # Yoga positions, such as a supported extended child's pose or garland pose | ||
# Mindfulness and/or 4 square breathing techniques can be used to draw awareness to tension held in the pelvic floor muscles and actively allowing the tension to decrease. | |||
The use of inserts can be beneficial along with these techniques. Teach the patient to move the insert past the entrance of the vaginal canal in conjunction with relaxing the pelvic floor muscles. | |||
|- | |- | ||
|Pain centralization | |Pain centralization | ||
|If this has been a chronic issue, addressing principles of centralized pain and explaining this to the patient can be helpful and informative | |If this has been a chronic issue, addressing principles of centralized pain and explaining this to the patient can be helpful and informative. | ||
|} | |} | ||
'''Additional Considerations''' | '''Additional Considerations''' | ||
* The use of a multidisciplinary approach with the inclusion of a physician and a counselling therapist could | * The use of a multidisciplinary approach with the inclusion of a physician and a counselling therapist could be beneficial. | ||
* | * Issues such as stress or history of abuse can contribute to the tension of the pelvic floor muscles and this may be addressed through counselling. | ||
'''Medical management''' | |||
Ensure that the patient has been screened by a physician to rule out any differential diagnoses or address co-existing diagnoses that are out of the physiotherapy scope of practice. This could include women in the post-menopausal phase of life, may be dealing with dyspareunia due to changes in hormone levels which affects the genital tissue. If this is a contributing factor, it should be addressed by a physician. | |||
== Potential Contributing Factors == | == Potential Contributing Factors == |
Revision as of 00:24, 22 February 2019
Dyspareunia[edit | edit source]
*Page currently undergoing editing, please check back soon.
Definition[edit | edit source]
Dyspareunia is defined as persistent genital pain that occurs during sexual intercourse.[1]
Clinically Relevant Anatomy[edit | edit source]
Clinical Presentation[edit | edit source]
Subjective History
Symptoms
Individuals may present with pain that occurs at entry during penetration, with deep penetration or lasting post-penetration. Pain associated with the insertion of a tampon or a medical examination with the use of a spectrum, could also be another subjective report. Words used to describe pain may be (but are not limited to): "throbbing" "burning" or "aching."
Objective Assessment
A pelvic assessment, including an internal exam, performed by a trained medical professional with the informed consent of the patient. Through this exam the
Outcome Measures
The Female Sexual Destress Scale-Revised (FSDS-R): a single item from this scale may be a useful tool in quickly screening for sexual distress in middle-aged women.[2]
Level of dyspareunia pain (0-10)
Management / Interventions[edit | edit source]
Physiotherapy
Physiotherapists can address factors contributing to dyspareunia with the following tools and techniques.
Contributing factor | Tool/Technique |
---|---|
Lack of awareness of pelvic floor muscles | Assess the patient's ability to connect with their pelvic floor muscles through their ability to correctly contract and relax their pelvic floor muscles. If the patient is unable to correctly recruit these muscles, this might be a good place to begin therapy. |
Hypertension of pelvic floor muscles | Teaching relaxation techniques for the pelvic floor muscles:
The use of inserts can be beneficial along with these techniques. Teach the patient to move the insert past the entrance of the vaginal canal in conjunction with relaxing the pelvic floor muscles. |
Pain centralization | If this has been a chronic issue, addressing principles of centralized pain and explaining this to the patient can be helpful and informative. |
Additional Considerations
- The use of a multidisciplinary approach with the inclusion of a physician and a counselling therapist could be beneficial.
- Issues such as stress or history of abuse can contribute to the tension of the pelvic floor muscles and this may be addressed through counselling.
Medical management
Ensure that the patient has been screened by a physician to rule out any differential diagnoses or address co-existing diagnoses that are out of the physiotherapy scope of practice. This could include women in the post-menopausal phase of life, may be dealing with dyspareunia due to changes in hormone levels which affects the genital tissue. If this is a contributing factor, it should be addressed by a physician.
Potential Contributing Factors[edit | edit source]
- skin irritation (ie. eczema or other skin problems in the genital region)[1]
- endometriosis
- vestibulodynia
- vulvodynia[3]
- interstitial cystitis[3]
- fibromyalgia[3]
- irritable bowel syndrome[3]
- pelvic inflammatory disease[4]
- depression and/or anxiety[4]
- post-menopause[4]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380908/
- ↑ 3.0 3.1 3.2 3.3 Reed BD, Harlow SD, Sen A, et al. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol 2012; 120:145.
- ↑ 4.0 4.1 4.2 Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332:749.