Diagnosis and management of sexual pain disorders: Dyspareunia

Dyspareunia can be one of the most challenging complaints that providers encounter in the office setting. Ensuring adequate time and a comfortable setting to address a woman’s concerns is essential to evaluation and treatment. Understanding the broad differential diagnosis of painful intercourse guides history taking. A thorough, yet focused, pelvic examination is necessary to determine the cause of the sexual pain. Identifying the location of the pain is the first step in determining the diagnosis. Although specific conditions may be associated with dyspareunia, sexual pain often falls into the category of vulvodynia or more specifically provoked vestibulodynia. Sexual pain can significantly affect a woman’s well-being and quality of life. Restoration of lasting and satisfying sexual function often requires a multidimensional understanding of the condition. Providers should feel empowered to treat this condition with the information reviewed in this chapter.