Dyspareunia: Deep Thrust

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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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.

DIAGNOSTIC APPROACH

Differential Diagnosis

• Vulvitis
• Vestibulitis
• Vaginitis
• Bartholin’s gland infection, abscess, cyst
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