Evaluation and Treatment of Dyspareunia.pdfVIP

Clinical Expert Series Continuing medical education is available online at Evaluation and Treatment of Dyspareunia John F. Steege, MD, and Denniz A. Zolnoun, MD, MPH Dyspareunia affects 8–22% of women at some point during their lives, making it one of the most common pain problems in gynecologic practice. A mixture of anatomic, endocrine, pathologic, and emotional factors combine to challenge the diagnostic, therapeutic, and empathetic skills of the physician. New understandings of pain in general require new interpretations concerning the origins of pain during intercourse, but also provide new avenues of treatment. The outcomes of medical and surgical treatments for common gynecologic problems should routinely go beyond measures of coital possibility, to include assessment of coital comfort, pleasure, and facilitation of intimacy. This review will discuss aspects of dyspareunia, including anatomy and neurophys- iology, sexual physiology, functional changes, pain in response to disease states, and pain after gynecologic surgical procedures. (Obstet Gynecol 2009;113:1124–36) ain during intercourse is one of the most common study, 39% saw a physician or midwife, 20% recov- Pcomplaints in gynecologic practice. Together with ered after treatment, and 31% recovered spontane- chronic pelvic pain, it is also one of the more difficult ously. In many instances, women did not bring the clinical problems to assess and successfully treat. This complaint to the attention of their health care provid- review will discuss the following aspects of dyspareu- ers. Current practice of medicine in the United Sates nia: anatomy and neurophysiology, psychological in- certainly