Dyspareunia: a difficult symptom in gynaecological practice

Dyspareunia is pain genital pain associated with sexual function. It is a symptom that has a significant impact on women's health, relationships and quality of life. It is caused by different diseases and has organic and psychosexual components. Despite the high prevalence of sexual pain, few guidelines exist for its evaluation. Obtaining a comprehensive sexual history in an outpatient setting requires professionalism. A systematic and thorough examination of the lower genital tract is necessary to rule out anatomical causes. Other organ systems may need to be assessed from the medical history. Ultrasound may be appropriate to evaluate pelvic organs followed in some cases by diagnostic laparoscopy if there is evidence of endometriosis or utero-vaginal pathology that does not respond to conservative management. Psychosexual causes must be considered when assessing these patients. This article considers the diagnosis and investigation of women complaining of dyspareunia.