Dyspareunia: Deep Thrust

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Chapter 21 Dyspareunia: Deep Thrust

INTRODUCTION

Description: Abdominal, pelvic, or vaginal pain that arises during sexual thrusting, especially with deep penetration.

Prevalence: Roughly 15% of women each year (severe—less than 2% of women).

Predominant Age: Reproductive age and beyond.

Genetics: No genetic pattern.

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).

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.

CLINICAL CHARACTERISTICS

Signs and Symptoms

Ache-like pain, crampy visceral pain, burning, a sense of fullness, or a feeling as if something is being bumped during deep sexual thrusting. Occasionally the pain is sharp and abrupt in character. Pain often depends on the type of sexual activity involved or the positions used.

WORKUP AND EVALUATION

Laboratory: No evaluation indicated.

Imaging: No imaging indicated, pelvic (abdominal or transvaginal) ultrasonography for specific indications.

Special Tests: None indicated.

Diagnostic Procedures: History (general and sexual) and careful pelvic examination. (If discomfort is produced, it is important to be sure that the sensation matches that experienced during intercourse.)

Pathologic Findings

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation, reassurance, relaxation measures.

Specific Measures: Because dyspareunia is ultimately a symptom, the specific therapy for any form of sexual pain is focused on the underlying cause. Vaginal lubricants (water-soluble or long-acting agents such as Astroglide, Replens, Lubrin, K-Y Jelly, and others), local anesthetics (for vulvar lesions), or pelvic relaxation exercises may be appropriate while more specific therapy is under way.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance, relaxation training, alternate sexual positions and forms of expression; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP020 (Pain During Intercourse), AP042 (You and Your Sexuality [Especially for Teens]).

Drug(s) of Choice

The judicious use of anxiolytics or antidepressant medications for selected patients may be appropriate but for short periods of time only.

ALTERNATIVE THERAPIES

Modifying sexual techniques used by the couple may reduce pain with intercourse. Delaying penetration until maximal arousal has been achieved improves vaginal lubrication, ensures vaginal apex expansion, and provides an element of control for the female partner. Sexual positions that allow the women to control the direction and depth of penetration (such as woman astride) may also be of help.

FOLLOW-UP

Patient Monitoring: Normal health maintenance. Watch for signs of abuse, anxiety, or depression.

Prevention/Avoidance: None.

Possible Complications: Marital discord, orgasmic or libidinal dysfunction.

Expected Outcome: With diagnosis and treatment of the underlying cause, response should be good.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy. Occasionally, the coital changes necessitated by the growing uterus may result in new-onset dyspareunia. Positional changes (as noted earlier) are generally sufficient to relieve these cases.

ICD-9-CM Codes: 625.0.

American College of Obstetricians and Gynecologists. Vulvodynia. ACOG Committee Opinion 345. Washington, DC: ACOG, 2006.

Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update. 2005;11:595. Epub 2005 Sep 19

Fink P. Dyspareunia: current concepts. Med Aspects Hum Sex. 1972;6:28.

Fordney DS. Dyspareunia and vaginismus. Clin Obstet Gynecol. 1978;21:205.

Fullerton W. Dyspareunia. BMJ. 1971;2:31.

Lamont JA. Female dyspareunia. Am J Obstet Gynecol. 1980;136:282.

Lentz GM. Emotional aspects of gynecology: sexual dysfunction, eating disorders, substance abuse, depression, grief, loss. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:218.

Steege JF. Dyspareunia and vaginismus. Clin Obstet Gynecol. 1984;27:750.

Steege JF, Ling FW. Dyspareunia. A special type of chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:779.

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