Chapter 70 Dyspareunia: Insertional
INTRODUCTION
Description: Pain that occurs with sexual penetration is considered to be 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 interfere with penetration (vaginismus).
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, surgical repairs [colporrhaphy]), proctitis, trauma (acute or chronic sequelae), urethral diverticula, urethral syndrome, urethritis (bacterial or chlamydial), vaginismus, vulvar (atrophic vulvitis, chancroid, chemical irritation [deodorants, adjuncts, lubricants]), herpes vulvitis, hypertrophic vulvar dystrophy, lichen sclerosus, lymphogranuloma venereum, vestibulitis, vulvitis (infectious), vulvodynia.
CLINICAL CHARACTERISTICS
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 to localize the cause but are often generalized and nonspecific.
