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Dyspareunia in Women

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Dyspareunia (pain with intercourse) greatly affects the quality of life, libido, relationships, and self-image of the estimated 15% of women who have this condition.1 This prevalence increases in postmenopausal women with vulvovaginal atrophy.2 Dyspareunia prevalence, based on diagnostic coding, is likely underestimated because patients are often hesitant to discuss sexual pain with their clinician. Despite the preference of many patients to discuss these issues, clinicians may not initiate sexual health discussions because of a lack of time, lack of understanding about dyspareunia, or a perceived lack of importance.3 Clinicians can create a safe, confidential, professional encounter and initiate sexual health discussions with ubiquity statements such as “Many women may experience discomfort with sexual intimacy. Are there any sexual concerns you’d like to discuss?”

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Erin Gross, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9444 Medical Ctr Dr, La Jolla, CA 92093 (eagross@health.ucsd.edu).

Published Online: April 18, 2022. doi:10.1001/jama.2022.4853

Conflict of Interest Disclosures: Dr Brubaker reported receiving compensation from UpToDate and Female Pelvic Medicine & Reproductive Surgery and grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

References
1.
Wheeler  LJ , Guntupalli  SR .  Female sexual dysfunction: pharmacologic and therapeutic interventions.   Obstet Gynecol. 2020;136(1):174-186. doi:10.1097/AOG.0000000000003941PubMedGoogle ScholarCrossref
2.
Shifren  JL .  Genitourinary syndrome of menopause.   Clin Obstet Gynecol. 2018;61(3):508-516. doi:10.1097/GRF.0000000000000380PubMedGoogle ScholarCrossref
3.
Parish  SJ , Hahn  SR , Goldstein  SW ,  et al.  The International Society for the Study of Women’s Sexual Health process of care for the identification of sexual concerns and problems in women.   Mayo Clin Proc. 2019;94(5):842-856. doi:10.1016/j.mayocp.2019.01.009PubMedGoogle ScholarCrossref
4.
Meister  MR , Sutcliffe  S , Ghetti  C ,  et al.  Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain.   Am J Obstet Gynecol. 2019;220(3):255.e1-255.e9. doi:10.1016/j.ajog.2018.11.1106PubMedGoogle ScholarCrossref
5.
Burrows  LJ , Goldstein  AT .  The treatment of vestibulodynia with topical estradiol and testosterone.   Sex Med. 2013;1(1):30-33. doi:10.1002/sm2.4PubMedGoogle ScholarCrossref
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