Dyspareunia: Deep Thrust

Causes

• Gynecologic —extrauterine (adhesions, chronic pelvic infection, cysts, endometriosis, pelvic relaxation [cystocele, urethrocele, rectocele, enterocele], prolapsed adnexa or adnexa adherent to vaginal apex, retained ovary syndrome, shortening of the vagina after surgery or radiation); uterine (adenomyosis, fibroids, malposition [retroversion]).

• Urologic —chronic urinary tract infection, detrusor dyssynergia, interstitial cystitis, urethral syndrome.

• Gastrointestinal —chronic constipation, diverticular disease, inflammatory bowel disease (Crohn disease, ulcerative colitis), irritable bowel syndrome.

• Musculoskeletal —fibromyositis, hernias (abdominal, femoral), herniated disk.

• Other —inadequate arousal (failure of vaginal apex expansion), pelvic tumors (benign or malignant). Care must be taken to avoid labeling any dyspareunia as purely physical or purely emotional in origin. Most often a mixture of factors causes or contributes to the problem.

• Risk Factors: Positions or practices that result in particularly deep or forceful penetration, such as male superior or rear-entry positions. Prior surgery, particularly following mesh placement for pelvic organ prolapse, or cosmetic procedures such as “vaginal rejuvenation.”