Dyspareunia and other psychosexual problems
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
This chapter examines the classification and causes of dyspareunia. It discusses the epidemiology, aetiology, pathogenesis, clinical features and prognosis of psychosexual and sexual problems and the links with gynaecological disease. Dyspareunia can be primary, where pain has always occurred, or secondary, where it occurs after a period of pain-free sexual activity. The aetiology of dyspareunia should be viewed on a continuum from primarily physical to primarily psychological, with many women exhibiting components of both. Psychosexual problems may present to the gynaecologist as part of general history taking for a variety of presenting complaints, and it is sometimes difficult to disentangle how much of the gynaecological complaint is due to the psycho-sexual problem, or whether the gynaecological problem has caused the psychosexual issue. It is extremely important that the clinician feels comfortable asking about sexual problems, especially in relation to gynaecological problems, for which there is a good chance of concomitant psychosexual issues, such as vulval disorders and dyspareunia.
Treatment of Uterine Anomalies
Togas Tulandi in Reproductive Endocrinology and Infertility, 2002
The mu¨llerian anomalies represent a group of malformations that result from abnormal formation or incomplete fusion of the mu¨llerian ducts. Congenital uterine anomalies most commonly are diagnosed after one or more failed pregnancies, which may manifest as recurrent miscarriage or as mid-trimester loss, or after malpresentation of the fetus at delivery. Also more frequent are abdominal delivery and postpartum complications such as retained placenta, subinvolution and hemorrhage. Mu¨llerian malformations lead to gynecologic complaints such as oligomenorrhea, dysfunctional uterine bleeding, and chronic pelvic pain and dyspareunia. A surgical emergency may occur, as in the case of the gestation in a rudimentary uterine horn [1]. Because many, if not most, women with such malformations have normal reproductive outcomes, it is important to understand the appropriate techniques used to diagnose these abnormalities, including septate, bicornuate, didelphic, and unicornuate uteri, and to have a clear clinical perspective regarding their treatment and subsequent pregnancy rates.
Female Genital Mutilation (FGM)
Maggie L Dwiggins in Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
The World Health Organization defines female genital mutilation (FGM) as “all procedures involving partial or total removal of the external female genitalia or injury to the female genital organs for non-medical reasons.” A clitoridectomy or the partial or total removal of the clitoris of the prepuce or clitoral hood. Infibulation or the narrowing of the vaginal opening. FMG is internationally recognized as a violation of human rights but is still being reported in 30 countries in Africa and in a few countries in Asia and the Middle East. FGM is practiced for a variety of sociocultural reasons with some who believe that FGM is a religious requirement, although it is not mentioned in any major religious text. Sexual functioning risks: Dyspareunia, decreased sexual satisfaction, reduced sexual desire and arousal, decreased lubrication during sexual intercourse, reduced frequency of orgasm or anorgasmia.
Prevalence and Risk Factors for Dyspareunia and Unsatisfying Sexual Relationships in a Cohort of Primiparous and Secondiparous Women After 12 Months Postpartum
Published in International Journal of Sexual Health, 2010
Serena Bertozzi, Ambrogio Londero, Arrigo Fruscalzo, Lorenza Driul, Diego Marchesoni
ABSTRACT Dyspareunia is a common short-term pregnancy complication, rarely lasting longer than 1 year after delivery. Our study aims to determine postpartum dyspareunia prevalence and its impact on women's sexual health. In this retrospective study, we asked 602 women about dyspareunia and the quality of sexual intercourse through telephone interviews. The influence of dyspareunia on the quality of sexual intercourse and couple relationship is scored on a 4-point verbal scale according to its severity. Data were analyzed by R (version 2.8.0), considering significant p < .05. Nearly 100% of women (99.9%) resumed their sexual activity; 16.2% of them reported dyspareunia significantly compromising their sexual intercourse and couple relationships. In univariate analysis, severe perineal tears are associated with persistent dyspareunia (p < .05). By multivariate analysis, postpartum dyspareunia results independently influenced by operative delivery, previous dyspareunia, recurrent urogenital infections and urge incontinence (p < .05), as well as by the Kristeller maneuver and partoanalgesia (p = .084) in the case of women who had a vaginal delivery. Dyspareunia significantly compromises women's sexual health postpartum, mostly caused by perineal trauma by means of delivery management and recurrent urogenital infections.
TX-004HR clinically improves symptoms of vulvar and vaginal atrophy in postmenopausal women
Published in Climacteric, 2019
J. A. Simon, R. Kagan, D. F. Archer, G. D. Constantine, B. Bernick, S. Graham, S. Mirkin
Objective: This study aimed to evaluate improvement of dyspareunia and associated vaginal dryness with a 17β-estradiol softgel vaginal insert (TX-004HR; TherapeuticsMD, Boca Raton, FL, USA) in women with postmenopausal vulvar and vaginal atrophy (VVA). Methods: Postmenopausal women with VVA and moderate to severe dyspareunia received TX-004HR (4, 10, or 25 μg) or placebo in the 12-week, randomized, double-blind, placebo-controlled, phase 3 REJOICE trial. Post hoc analyses examined improvement levels in dyspareunia and concurrent vaginal dryness with TX-004HR and assessed the effects of patient characteristics on vaginal dryness treatment. Results: Significantly more women treated with TX-004HR (all doses) than placebo had complete resolution or substantial improvement in dyspareunia or vaginal dryness (concurrent with dyspareunia) by 12 weeks, observed as early as week 2 with most doses. TX-004HR significantly improved both dyspareunia and vaginal dryness at least one level versus placebo by week 12 in women with both symptoms. Subgroup analyses showed TX-004HR improved vaginal dryness associated with dyspareunia regardless of age, body mass index, uterine status, prior pregnancy, and vaginal birth number. Conclusion: TX-004HR provided clinically meaningful improvements in dyspareunia and vaginal dryness associated with dyspareunia in postmenopausal women with VVA. Clinicians may be able to use this information when discussing patients’ expectations regarding symptom improvement with the estradiol vaginal insert.
Dyspareunia is associated with chronic pain in premenopausal women with sickle cell disease
Published in Hematology, 2018
Matthew S. Karafin, Meenu Singh, Mamaram Ceesay, Sumana Koduri, Liyun Zhang, Pippa Simpson, Joshua J. Field
ABSTRACT Objectives: Pain is common in women with sickle cell disease (SCD), but the prevalence of dyspareunia in this unique patient population is unknown. In this study, we sought to determine whether chronic pain is associated with an increased prevalence of dyspareunia in premenopausal women with SCD. Methods: A cross-sectional study of premenopausal women with SCD was systematically assessed for symptoms of dyspareunia and chronic pain using a standard questionnaire. These results were correlated with each subject's clinical pain phenotype determined by a review of the patient's electronic medical record. Results: Ninety-one premenopausal women with SCD were examined. Thirty-two percent of the women reported dyspareunia. Women with dyspareunia were more likely to have a history of chronic pain (90% versus 61%, p = .006), report more pain days per week (median (interquartile range): 6 (4–7) vs. 3 (0–7), p = .005)), and had a higher oral morphine equivalent dose (145 (45–226) mg vs. 60 (9–160) mg, p = .030). Using a multivariable classification tree analysis, number of days of pain experienced per week was an important predictor of dyspareunia (p = .001). Conclusion: Dyspareunia is common in women with SCD, and more common in women with SCD and chronic pain. Providers should assess women with SCD for dyspareunia, especially those with a chronic pain syndrome.
Related Knowledge Centers
- Cervix
- Vaginismus
- Pain
- Pelvic Floor
- Congenital Disorder
- Vaginal Lubrication