Dyspareunia: a complex problem requiring a selective approach

Abstract

Dyspareunia frequently has a multifactorial aetiology. The problem with the term is that it is not specific enough and does not allow for proper discussion of the very important problem of pain with sexual intercourse, a problem that can be very disturbing to a couple's relationship. We present two cases of patients who had multiple potential anatomic reasons for dyspareunia. The clinical picture, treatment strategy and the complex nature of deep penetration pain was discussed. We also proposed a new way of defining dyspareunia to allow a more adequate way of studying and discussing the problem.

Intra-ligamentous fibroid removed laparoscopically

“…We have reported previously on the common multifactorial nature of chronic pelvic pain [10]. This patient is yet another example of this concept.…”

Uterine peaking – sonographic sign of vesico-uterine adhesion

“…Patients with dense vesico-uterine adhesions are often women with multiple C-sections in their past and often suffer from deep penetration dyspareunia due to limited mobility of the cervix and bladder base [2]. This is a very common problem and can be very disruptive to marital relationship.…”

“…Internal adhesions and scar tissue are a very common side effect of this procedure. Adhesions begin forming almost immediately after surgery and for many women adhesions are painless and remain silent; however for others they may cause chronic pelvic pain, dyspareunia, or even bowel obstruction [2]. …”

Total laparoscopic hysterectomy with obliterated anterior cul-de-sac

“…Surgical intervention to release a scarred obliterated anterior cul-de-sac is associated with a significant risk of intraoperative bladder injury [7], [8], [9]. Other reasons for vesicouterine adhesions may be previous cesarean deliveries or anterior uterine wall myomectomy [8], [9], [10], [11]. …”