Dyspareunia
Author:
Dr. Chang Min-Chieh
Affiliations:
National Defense Medical Center, Taiwan (R.O.C)
THIS ARTICLE IS EXCERPTED FROM:
2024 TAOG Taiwan Association of Obstetrics and Gynecology Annual
Scientific Conference DATE:20240310
Original article by Dr. Chang Min-Chieh
Dyspareunia…The location of pain does not necessarily indicate its origin.”
Abstract
OVERVIEW AND BACKGROUND[1]
DEFINITION:
Dyspareunia is recurrent or persistent genital pain DURING sexual intercourse. It is a significant devastating effect on women’s health, relationships and quality of life.
PREVALENCE:
The prevalence of dyspareunia varies from 8% to 21.1% globally, as reported by the World Health Organization in 2006[2].
SYMPTOMS:
Dyspareunia may have throbbing, burning pains, pelvic cramping, or muscle tightness or spasms. Just before, during, or after sexual intercourse, involve the genitals.
ETIOLOGY:
There is no precise etiology, A variety of factors, both physical to psychological can contribute.
TREATMENT:
Treatment normally focuses on the underlying cause,and performed multidisciplinary approach.
RESULT: no etiotropic effect
So far all papers show that the cause of dyspareunia is caused by multiple factors, so the treatment is also based on possible causes, effects vary.
THE PURPOSE OF THIS ARTICLE
3 OPINIONS are suggested
Since 2019 to 2023, our outpatient clinic has treated 28 female dyspareunia , ranging from 25 to 71 years old, with an average age of 46.5 years old.
The average time from onset to referral to our clinic was 3 years.
All patients came to our clinic from various hospitals, clinics and even teaching hospitals ,Almost all patients were
excluded.
1. Vaginal dryness
2. Vaginal atrophy
3. Hormone replacement therapy
4. Postpartum scars
5. Vaginal and vulvar inflammation, PID
6. Emotional stress, anxiety, vaginismus, etc.
7.uterine fibroids and adenomyosis. endometriosis ,cervical
cancer
8. Exclude uterine retroversion and uterine prolapse.
Pelvic floor muscle dysfunction .
The above factors were current opinions about cause
of dyspareunia.
Methology:
We treated all the 28 cases with single modal treatment“endocervical cauterization”instead of multidisciplinary approach.
The average treatment period is 132 days.
Result:
“The average duration between the satisfaction survey and the completion of treatment is 455 days.”
The PAIN TREATMENT SATISFACTION SCALE (PTSS)[3]
On a scale of 1 to 10
0: stands for no pain
Between 0 to 10 Is mild to moderate.
10:stands for worst pain possible
0:9 persons 32% 1: 4 persons 14% 2: 5 persons 17%
4: 1 person
3% 5: 6 persons 21% 10: 3 persons 10%
PTSS :average IS 2.8
The pain degreeis mostly 2 or 3 on the Marinoff Dyspareunia
Before treatment:
The pain degree is mostly 0 or 1 on the Marinoff Dyspareunia[4]
at the telephone satisfaction survey
Discussion:
the pudendal nerve is innervation of the pelvic region, including the cervix, Pudendal neuralgia, like vulvodynia, is a pain condition diagnosed clinically in the absence of other pathology.
Characteristic symptoms include urinary frequency and urgency, dysuria, dyschezia, vaginal burning, dyspareunia, Pudendal Neuralgia may also result from certain infections[5].
Conclusion: 30 years experience,,our recognition that “endocervicitis” is a primary cause of dyspareunia.
We do not treat vulva or vagina rather only treat the cervix area by endocervical cauterization. The sexual pain disappears after treatment.
1. Dyspareunia has a main “single cause” ……”Endocervicitis”
2.Dyspareunia is treated by a major “single modality treatment” “endocervical cauterization”
3.“The location of pain does not necessarily indicate its origin.”
Citation
(1)
Sorensen J,
Bautista KE, Lamvu G, Feranec J. Evaluation and Treatment of Female Sexual
Pain: A Clinical Review. Cureus. 2018 Mar 27;10(3):e2379. doi:
10.7759/cureus.2379. PMID: 29805948; PMCID: PMC5969816.
(2) Oyelowo, Tolu. “Dyspareunia.”
Dyspareunia – an Overview | ScienceDirect Topics, 2007,
www.sciencedirect.com/topics/medicine-and-dentistry/dyspareunia.
(3)
Evans CJ, Trudeau E, Mertzanis P, Marquis P,
Peña BM, Wong J, Mayne T. Development and validation of the Pain Treatment
Satisfaction Scale (PTSS): a patient satisfaction questionnaire for use in
patients with chronic or acute pain. Pain. 2004 Dec;112(3):254-266. doi:
10.1016/j.pain.2004.09.005. PMID: 15561380.
(4)
Karimi F,
Babazadeh R, Zojaji A, Jouya S. Squill oil for decreasing dyspareunia and
increasing sexual satisfaction in menopausal women: A triple-blind randomized
controlled trial. Avicenna J Phytomed. 2021 Sep-Oct;11(5):464-472. doi:
10.22038/AJP.2021.17777. PMID: 34745918; PMCID: PMC8554279.
(5)
Ruoss CM, Howard
EA, Chan K, Stevenson PG, Vancaillie T. Topical treatment of vulvodynia,
dyspareunia and pudendal neuralgia: A single clinic audit of amitriptyline and
oestriol in organogel. Aust N Z J ObstetGynaecol. 2021 Apr;61(2):270-274. doi:
10.1111/ajo.13292. Epub 2021 Jan 11. PMID: 33427301; PMCID: PMC8247999.
Contact Us:
Telephone: +886 7 611-8991
