Dyspareunia

Question 1

Etiology of superficial

Answer 1

1. Inflammatory:
Atopic/contact dermatitis
Other dermatological
2. Infections
Vulvovaginitis
HSV
Interstitial vaginitis
UTI
3. Mucosal dysfunction
Irradiation
Medications reducing lubrication->COCP, antiD
Primary inadequate lubrication
4. Structural
Imperforate
Bartholins mass/abscess
Vulvar dystrophies
Perineal injury
5. Musculoskeletal
Vagnismus
6. Other
Psychosexual

Question 2

Etiology of deep

Answer 2

1. Infectiuos/inflammatory
Endometriosis
Pelvic infection
2. Structural
Ovarian cysts or other ovarian lesions
Adenomyosis
Fibroids
3. MSK
Levator ani sasm

Question 3

Define primary dyspareunia

Answer 3

Pain associated with intercourse since onset of sexual activity

Question 4

Secondary

Answer 4

Acquired over sexual lifetime

Question 5

Investigations

Answer 5

Depending on history
1. Vaginal sample for pH and "whiff" test->bacterial vaginosis, trichomonas, candida
2. Gonorrhea and chlamydia
3. HSV PCR
4. Urinalysis
5. Pelvic USS
6 Diagnostic laparoscopy
7. Cystoscopy->interstitial cystitis
8, Vulvovaginal biopsy for suspicious lesions