Approach dyspareunia Location Entry vs Deep Onset During or after intercourse Pruritic pain vaginitis Aching pelvic congestion Single site or multiple sites which site came first expectation of pain ID: 931835
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Slide1
Approach dyspareunia
Pawin Puapornpong
Slide2Approach dyspareunia
Location: Entry
vs
Deep
Onset: During or after intercourse
Pruritic
pain:
vaginitis
Aching: pelvic congestion
Single site or multiple sites which site came first: expectation of pain
Situational or generalized:
psychologic
Positional: pain minimized with women superior position
Slide3Approach dyspareunia
Other sexual dysfunction: arousal disorders
Vaginal symptoms:
discharge,odor
>>
vaginitis
History of STD: PID
Obsteric
history; postpartum
dyspareunia
Surgery or radiation: vaginal stricture
Contraception method: risk of
PID,trauma
/irritation
Slide4Approach dyspareunia
Medical causes:
DM,IBS,skin
disorder
Psychological causes:
Depression,anxiety
Slide5Superficial dyspareunia
Vaginismus
Vaginal infection
Episiotomy scars & narrow vagina
Insufficient vaginal lubrication
Atrophic vagina due to menopause
Slide6Vaginismus
Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with intercourse
Etiology: Unknown
PE: Palpable spasm of vaginal musculature, difficult inserting speculum
Slide7Insufficient vaginal lubrication
Well-delineated entry pain, vaginal pain, vaginal
dryness,friction,irritation,difficulty
and pain with penetration
Etiology: Estrogen
deficiency,arousal
-phase difficulty
PE:inspection
of pubic
hair,labia
fullness, vaginal
mucosa,vaginal
depth
Slide8Deep dyspareunia
PID
Endometriosis
Ectopic pregnancy
Pelvic congestion
Slide9Pelvic inflammatory disease
Deep pain
Etiology: Infection
PE:
discharge,uterine
tenderness or cervical motion tenderness
Slide10Endometriosis and pelvic adhesion
Deep pain, cyclic pain with menses complaint of “Something being bumped into”
Etiology: unknown
PE:Nodules,Fixed
uterus or
adnexa
Slide11Pelvic congestion
Postcoital
ache, deep pelvic pain
Etiology: unknown
PE: Unremarkable
Slide12Management
Aimed at identifying & properly treating the underlying cause
Adequate lubrication
Topical
oestrogen
for atrophic vagina
Surgery : vaginal
prolapse
or
pelvic pathology
Slide13Differential diagnosis
Dyspareunia
Vulvodynia
Vaginismus
Atrophic tissue or impaired lubrication
Endometriosis&pelvic
adhesion
Adnexal
pathology
R/V
uterus,uterine
fibroid
Chronic
cervicitis:PID,Endometritis
Pelvic congestion
Urethral
disorders:cystitis
Slide14Thank you