Dyspareunia in gynaecological practice

Dyspareunia is defined as genital pain experienced just before, during or after sexual intercourse. It can significantly affect quality of life. It is a symptom of a variety of disease states with components of both physical and psychological dysfunction.It is important to obtain a comprehensive sexual history and perform a systematic examination of the lower genital tract to exclude any underlying pathology. Further investigations such as ultrasound rarely offer additional information. Diagnostic laparoscopy is an invasive procedure that is of limited use in the management of dyspareunia but may 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. Studies suggest that medical treatment for endometriosis is effective when commenced on clinical diagnosis alone without laparoscopic confirmation. Psychosexual causes are important to consider during the assessment of the patient experiencing dyspareunia.