Dyspareunia

Dyspareunia (from Greek dyspareunos — poorly matched) is a sexual dysfunction characterized by persistent or recurrent genital pain.

Pain may occur immediately before, during, or after intercourse, leading to significant personal distress and avoidance of sexual intimacy.

Etiology and pathophysiology

Classification is based on the depth of pain occurrence:

1. Introital (superficial) dyspareunia: Pain is localized in the vulva and vaginal entrance. Pathogenesis may be associated with infectious-inflammatory processes (vulvitis, candidiasis, bartholinitis), microtraumas (posterior commissure tears), or reflex spasm of pelvic floor muscles (vaginismus). In postmenopause, the leading cause is atrophic vaginitis, where estrogen deficiency causes thinning of the epithelium and reduced lubrication.
2. Deep dyspareunia: Pain occurs in the pelvis during deep penetration (friction). Pathogenesis is due to a mechanical factor: displacement of organs fixed by adhesions, pressure on inflamed appendages, or direct physical impact on endometriotic infiltrates located in the retrocervical tissue and sacro-uterine ligaments.

Clinical significance

Deep dyspareunia is a highly specific and often the only early symptom of infiltrative endometriosis affecting the Douglas pouch (retro-cervical endometriosis). It is also characteristic of chronic pelvic adhesions following pelvic inflammatory disease. Complaint of pain during intercourse requires mandatory bimanual examination and often diagnostic laparoscopy to identify any organic cause.