Evaluation and Management of Sexual Pain in Females

It is estimated that up to 21% of women worldwide experience significant pain during intercourse at some point in their lifetime. Research shows that most women suffer in silence for years before they obtain proper care. Pain during intercourse, or dyspareunia, can be classified into superficial dyspareunia (pain with entry affecting the vulvar vestibule or vaginal introitus) or deep dyspareunia (internal pain with vaginal penetration). Superficial dyspareunia can be associated with vaginal dermatosis, atrophic vaginitis, vulvovaginitis, and vulvodynia, whereas deep dyspareunia is commonly caused by endometriosis, adhesions, fibroids, and cervicitis. Dyspareunia can occur before, during, or following intercourse and can be found along with interstitial cystitis, irritable bowel syndrome, and/or sexual abuse. In spite of the negative impact it has on women’s lives, this condition often goes unrecognized, undiagnosed, and untreated. Many times patients have difficulty discussing this ‘private’ subject with their providers, and providers often do not know how to properly evaluate women for sexual pain. This lecture will discuss many of the myths associated with sexual pain and how sexual pain fits the biopsychosocial model of pain. Useful to all healthcare providers, a comprehensive guideline for the evaluation and management of this disorder will be formulated. (Recorded at PAINWeek 2017)