Name
DYSPAREUNIA
DESCRIPTION
DETAIL
CAUSES : 1. ADNEXAL CAUSES : - INFECTION - OVARIAN CYST OR NEOPLASM - ENDOMETRIOSIS INVOLVING TUBES, OVARIES OR PERITONEUM - PROLAPSED TENDER OVARIES WITH RETROVERTED UTERUS 2. VULVAR OR VAGINAL CAUSES : - CONGENITAL ABSENCE OF THE LOWER PART OF VAGINA - UNRUPTURED HYMEN - INFECTION - VULVITIS OR HERPETIC VULVITIS - CONDYLOMA ACUMINATUM - CYST OR ABSCESSES OF BARTHOLIN GLANDS - ENTEROVAGINAL FISTULA ( RARE ) - DISPERITY IN SIZE - VULVAL DYSTROPHY - HYPERPLASTIC ( LEUCOPLAKIA) OR HYPOPLASTIC (ATROPHIC) - HEALED PERINEAL LACERATIONS GIVING RISE TO NARROW INTROITUS - URETHRAL CARUNCLE - URETHRITIS - CYSTITIS 3. VAGINISMUS 4. CERVICITIS OR CERVICAL CANCER 5. OTHER CAUSES - ANAL FISSURE - THROMBOSED PILES - FUNCTIONAL -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS : β’ Vaginismusβ’ Gonorrhea culture β’ Wet mount β’ Chlamydia culture β’ Herpes culture β’ Urine analysis β’ Urine culture β’ Pap smear to assess estrogen status IMAGING : β’ Voiding cystourethrogram if urinary tract involvement β’ Gastrointestinal contrast studies if GI symptoms β’ US and CT of limited value; perform if clinically indicated DIAGNOSTIC PROCEDURES ; β’ Colposcopy and biopsy if vaginal/vulvar lesions β’ Laparoscopy if complex deep penetration pain β’ Cystoscopy if urinary tract involvement β’ Sigmoidoscopy if GI involvement
TYPENOTES
RISK FACTORS β’ Diabetes β’ Estrogen defi ciency β’ Alcohol/marijuana consumption β’ Menopause β’ Medroxyprogesterone use β’ Stress β’ Fatigue or overwork β’ Lactation β’ Vaginal surgery β’ Medication side effects (antihistamines, tamoxifen)GENERAL MEASURES : . The fi rst step in treatment is to educate the patient and partner as to the nature of the problem and reassure them the problem can be solved . Organic causes can generally be identified during the initial evaluation and specific treatment initiated . Once organic causes have been ruled out, individual and/or couple behavioral therapy should be initiated . Behavioral therapy . Designed to systemically desensitize to intercourse through a series of interventions over a period of weeks . Interventions range from muscle relaxation and mutual body massage to sexual fantasies and erotic massage, with the ultimate goal of intercourse and sexual responsiveness . Individual therapy . Indicated to help the patient deal with intrapsychic issues and assess the role of the partner . Couple therapy . Indicated to help resolve interpersonal problems . May involve short-term structured intervention or sexual counseling . Referral for long-term therapy may be necessary SURGICAL MEASURES : . Should be avoided . Surgical vestibulectomy can be considered when conservative measures fail with vulvar-vestibulitis ACTIVITY : Routine; sitz baths may relieve painful inflammation DIET : Regular; a high-fiber diet may help if constipation is the cause DRUG(S) OF CHOICE : . Dependent on the etiology. May include antibiotics, antifungals and antivirals for infection; estrogen for vaginal atrophy; analgesics and topical anesthetics for pain; and lubricants for dryness. . Vulvar vsetibulitis/vulvodynia may respond to tricyclic antidepressants or gabapentin. PATIENT MONITORING: Dependent on therapy. Every 6-12 months once resolved. PREVENTION/AVOIDANCE : β’ Avoidance of alcohol and tobacco products β’ With vulvar vestibulitis: proper vulvar hygiene including avoidance of soaps; aqueous creams or emulsifying ointments may be of benefit EXPECTED COURSE/PROGNOSIS : The majority of cases will respond to treatment
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
URINE ROUTINE, URINE CULTURE TEST, PAP"S SMEAR, ULTRA SOUND WHOLE ABDOMEN - FEMALE, COMPLETE BLOOD COUNT, PUS CULTURE TEST, GRAM STAINING