Dyspareunia in Women: 10 Questions for Consideration in Primary Care
Dyspareunia affects approximately 15% of women, according to a recent article in JAMA Insights Women's Health, and the prevalence increases in postmenopaual women. The authors suggest that prevalence, when based on diagnostic coding, however, is probalby underestimated as patients may be reluctant to discuss sexual pain. The hesitance to raise the topic, they say, is unfortunate given the signficant negative impact dyspareunia has on self perception, libido, relationships, and overall quality of life.
The article is an excellent primer for primary care clinicians who are in a position to treat dyspareunia from a range of causes. Before reading it, though, try these 10 questions based on the information covered and learn what you do and don't know about the condition.
1. Dyspareunia (pain with intercourse) is estimated to affect what percentage of women?
Answer: C. 15%. Estimates are that approximately 15% of women experience dyspareunia which can significantly affect quality of life, libido, and relationships.
2. True or False: Dyspareunia is nearly always related to a problem in the reproductive organs.
Answer: B. False. Although the female reproductive organs can be the cause of dyspareunia in some women, there are other potential etiologies.
3. True or False. The potential for dyspareunia increases after a woman has passed menopause
Answer: A. True. The risk for dyspareunia increases post-menopause primarily as a result of vulvovaginal atrophy
4. True or False. Primary care physicians can expect women with dyspareunia to self-report the condition.
Answer: B. False. A number of issues may keep women from complaining of dyspareunia including not recognizing its importance; thinking that it may not be successfully treated; or a clinician’s perceived lack of interest in the details about their patients’ sex lives.
5. Superficial pain in dyspareunia is more likely than deep pain with the condition to be associated with which of the above?
Answer: A. Problems in the vulva or the vestibule. Dyspareunia pain that is superficial usually implicates these structures vs endometriosis, pelvic floor muscle spasm or a labral tear which are all more likely to cause deep pain.
6. All the above are potential causes of dyspareunia except which one?
Answer: C. Spinal stenosis. Spinal stenosis is not a likely cause of dyspareunia.
7. True or False. Most cases of dyspareunia are successfully managed with OTC vulvovaginal moisturizes and sexual lubricants.
B. False. OTC vulvovaginal moisturizes and sexual lubricants are rarely sufficient to manage most cases of dyspareunia.
8. Which of the following therapies might be beneficial as treatment for dyspareunia?
Answer: E. All the above. The multiple potential etiologies of dyspareunia require that a variety of therapies be considered.
9. True or False. Referral to a mental health clinician is only indicated if the primary care physician believes dyspareunia is related to a mental disorder.
Answer: B. False. Referral to a mental health specialist may be beneficial during treatment for dyspareunia whether a mental health disorder is identified or not; the condition itself and some treatments may cause emotional distress.
10. Primary care physicians can manage many cases of dyspareunia but should consider referral to a gynecologist or sexual health specialist for which of the above?
Answer: E. All the above. Many common causes of dyspareunia are within the clinical scope of primary care, but some may require specialized skills. Referrals to colleagues in appropriate specialties should be considered in those cases.
