DYSPAREUNIA
By Dr. Jeevaretanam MBBS (Ind) MOG (UKM)
Consultant Obstetrics & Gynaecologist

Dyspareunia is defined as painful sexual intercourse. It can be divided into two disticnt groups.
i) Superficial - introital pain and
ii) Deep - pelvic pain

SUPERFICIAL
Vulval Causes
a) Infective - Herpes Simplex Virus (HSV) or Human Papilloma Virus (HPV)
b) Vulval dystrophy - menopause
c) Traumatic - episiotomy scar
d) Atrophic - old age
e) Vulval carcinoma

Vaginal Causes
a) Congenital causes - stenosis/bands
b) Infective - HSV/HPV/Candida
c) Bartholin's cyst/abscess
d) Fistula
e) Vaginal carcinoma
 
DEEP
Cervical
a) Infective - specifically HSV
b) Carcinoma

Uterus
a) Endometritis
b) Adenomyosis
c) Retroversion - due to fibroid

Adnexae
a) Endometriosis
b) Ovarian cyst
c) PID - Pelvic Inflammatory Disease
d) Ectopic pregnancy
e) Hydrosalpinx

Extra Pelvis
a) Appendicitis
b) Inflammatory bowel Disease
c) TB
d) Constipation

INVESTIGATION
a) Local Examination
b) Laparoscopy for deep dyspareunia

TREATMENTS
a) Treat the cause
b) Expert counseling is the above conditions are ruled out