Dyspareunia
Dyspareunia[edit | edit source]
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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]
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.
Physiotherapy
Physiotherapists can address factors contributing to dyspareunia.
| Contributing factor | Tool/Technique | ||
|---|---|---|---|
| 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 | ||
| Hypertension of pelvic floor muscles | Teaching relaxation techniques for 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 also beneficial.
- Stress can contribute to the tension of the pelvic floor muscles and this could be managed through counselling.
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.
