Dyspareunia: Insertional

Introduction

• Description: Pain that occurs with sexual penetration is insertional dyspareunia. This may be in the form of mild discomfort that may be tolerated, pain that completely prevents intromission, or any level of pain in between. In severe cases, pain may lead to severe vaginal spasms that prevent penetration (vaginismus).

• Prevalence: Approximately 15% of women each year (severe, <2% of women).

• Predominant Age: Reproductive age and older.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Congenital factors (duplication of the vagina, hymenal stenosis, vaginal agenesis, vaginal septum), cystitis (acute or chronic), hemorrhoids, inadequate lubrication (abuse [current or past], arousal disorders, insufficient foreplay, medication, phobias), pelvic (levator) muscle spasm, pelvic scarring (episiotomy, childbirth injury, surgical repairs [colporrhaphy]), phobias, proctitis, trauma (acute or chronic sequelae), urethral diverticula, urethral syndrome, urethritis (bacterial or chlamydial), vaginismus, vulvar, atrophic vulvitis and genitourinary syndrome of menopause, chancroid, chemical irritation (deodorants, adjuncts, lubricants), herpes vulvitis, hypertrophic vulvar dystrophy, lichen sclerosus, lymphogranuloma venereum, vestibulitis, vulvitis (infectious), vulvodynia. Some medications, including antiestrogenic agents, gonadotropin-releasing hormone agonists, and combination oral contraceptives, can reduce vaginal lubrication.

• Risk Factors: Those associated with causal pathologic conditions.

Signs and Symptoms

Sharp, burning, or pinching discomfort felt externally (vulva and perineum) during attempts at vaginal penetration (not limited to the penis). The discomfort is generally localized to the vulva, perineum, or outer portion of the vagina. The symptoms may help localize the cause but are often generalized and nonspecific.

Diagnostic Approach