Chronic Dyspareunia is defined as, painful vaginal intercourse of greater than six months duration. Some women have always had pain with vaginal penetration (Primary Dyspareunia), while the majority experience pain at some later date (Secondary Dyspareunia). Pain during vaginal intercourse could be elicited either by the initial superficial penetration (Introital Dyspareunia), and/or by the deep vaginal thrust (Deep Dyspareunia). Numerous medical conditions can contribute to the development of Dyspareunia; hence the importance of a multidisciplinary approach to better evaluate its causes and modes of therapy.

A. PRIMARY DYSPAREUNIA

Anatomical
Narrow introitus/short perineum
Imperforate hymen

Psychosexual
Sexual dysfunction
Neuroticism

B. SECONDARY DYSPAREUNIA

1. Entrance or Introital dyspareunia

Allergenic conditions

Vulvar Vestibulitis Syndrome
Anatomical
HPV
Recurrent monilia vulvovaginitis
Altered vaginal pH
Irritants
Chemical Rx
Destructive modalities
Idiopathic

Myalgias
Levator ani myalgias
Prolonged Kegel exercises

Psychosexual
Marital dysharmony
Vaginismus
Essential vulvodynia

Urethral/Bladder conditions
Chronic urethritis
Urethral syndrome
Interstitial cystitis

Systemic diseases
Crohn’s disease
Behcet’s disease
Discoid lupus
Pemphigus
Tuberculosis
Herpes Simplex
Syphilis
Lynphogranuloma venereum
Hydradenitis suppurativa
Pyoderma
Fox-Fordyce disease

Vulvar Dystrophies
Lichen sclerosis
Hyperplastic vulvar dystrophy
Mixed dystrophy

Iatrogenic
Episiotomy granulation polyps
Vulvar adhesions
Vaginal strictures
Exostosis post pelvic fracture
Birth control pills

Cancer
Paget’s disease
Squamous cell carcinoma
Basal cell carcinoma

2. Deep thrust dyspareunia

Endometriosis

Pelvic adhesions

Pelvic congestion syndrome

Fixed uterine retroversion

Post surgical
Retained ovarian syndrome
Shortening of the vagina
Post proctocolectomy