Dyspareunia in Women


Am Fam Physician. 2021 May 15;103(10):597-604.

  Patient information: A handout on this topic is available at https://familydoctor.org/condition/dyspareunia.

Author disclosure: Dr. Hill does not have a formal relationship with any pharmaceutical company to disclose. A public database revealed a listing for Intrarosa, but this was not a direct payment or a violation of our conflict-of-interest policy. Dr. Taylor has no relevant financial affiliations to disclose.

Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be superficial, causing pain with attempted vaginal insertion, or deep. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression. Because discussing sexual issues may be uncomfortable, clinicians should create a safe and welcoming environment when taking a sexual history, where patients describe the characteristics of the pain (e.g., location, intensity, duration). Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab, assessing for focal erythema or pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, postpartum causes, pelvic floor dysfunction, endometriosis, and vaginismus. Treatment is focused on the cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections.

Dyspareunia, recurrent or persistent painful sexual intercourse, is common and can affect women's mental and physical health and relationships.1,2 The prevalence of dyspareunia in the United States is approximately 10% to 20% and varies by age and population.3 Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression.2,4 Many women seeking medical care for sexual pain report believing that their concerns are invalidated and dismissed.5 Dyspareunia is a complex disorder often involving both psychosocial and physical conditions, requiring a detailed genitourinary examination and clinician knowledge of risk factors and the multifactorial nature of the disorder. Recommendations for treating dyspareunia are determined by the patient's current anatomy.

Risk Factors

The Authors

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D. ASHLEY HILL, MD, is chair of the Department of Obstetrics and Gynecology at the AdventHealth Graduate Medical Education Program, Orlando, Fla.; a professor of obstetrics and gynecology at the University of Central Florida College of Medicine, Orlando; and medical director of AdventHealth Obstetrics and Gynecology, Central Florida Division, Orlando....

CHANTEL A. TAYLOR, MD, is a fellow in the Women's Health Junior Faculty fellowship at AdventHealth Orlando Family Medicine Residency.

Author disclosure: Dr. Hill does not have a formal relationship with any pharmaceutical company to disclose. A public database revealed a listing for Intrarosa, but this was not a direct payment or a violation of our conflict-of-interest policy. Dr. Taylor has no relevant financial affiliations to disclose.

Address correspondence to D. Ashley Hill, MD, 235 East Princeton St., Ste. 200, Orlando, FL 32804 (email: Ashley.Hill.MD@AdventHealth.com). Reprints are not available from the authors.


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