Dyspareunia in gynaecological practise

Dyspareunia is a form of sexual dysfunction that can significantly affect quality of life and cause relationship difficulties. It is a symptom of a variety of disease states with components of both physical and organic dysfunction. Obtaining a good sexual history in an outpatient setting requires high level of professionalism. A systematic examination of the lower genital tract is necessary to rule out any obvious cause, although further investigations such as ultrasound do not often offer additional information. Diagnostic laparoscopy is an invasive procedure that is of limited use in the management of dyspareunia but might help detect pelvic adhesions or endometriosis in those where this condition is suspected. Before embarking on a laparoscopy it is important for the patient to be aware of a management plan if the laparoscopy does not show any obvious cause. There are data to suggest that empirical medical treatment after clinical diagnosis of endometriosis is effective and has the advantage of avoiding any invasive procedures. Psychosexual causes are important to consider during the assessment of the patient experiencing dyspareunia.