Chapter 21 Dyspareunia: Deep Thrust
INTRODUCTION
Description: Abdominal, pelvic, or vaginal pain that arises during sexual thrusting, especially with deep penetration.
ETIOLOGY AND PATHOGENESIS
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’s disease, ulcerative colitis, irritable bowel syndrome (IBS).
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.
