Dyspareunia is the feeling of pain on, or shortly after sexual intercourse. It can be superficial (around the introitus) or felt deep inside. It affects approximately 10% of women to varying degrees and can have a medical cause, although often the cause is psychological. It is important that this is a diagnosis of exclusion though, and a psychological component is almost invariably present even if the cause if organic.
Men can also experience dyspareunia (due to infection, skin disorders, Peyronie's disease, post-ejaculatory pain syndrome), although this is less common.
Abdominal examination - looking for areas of tenderness or any masses
PV examination- carefully inspect vulva and vagina for any skin changes, signs of trauma, prolapse, masses etc and pinpoint any tenderness. Take note of any vaginal discharge, including its characteristics.
Assess for cervical excitation, uterine mobility and adnexal tenderness.
Women approaching menopause, and those who are sexually inexperienced are most at risk of experiencing dyspareunia. Bromocriptine (a dopamine agonist) may cause painful clitoral tumescence and so enquiries should be made as to it's use.
For best outcome, and especially important where there is a strong psychological component to the dyspareunia (either cause or reaction), the problem should be approached as a couple in much the same way as erectile dysfunction
See Institute of Psychosexual Medicine for more information.
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