Dyspareunia

Painful intercourse or pain with attempted intercourse.

About one third of sexually active women > 65 report dyspareunia. Causes include inadequate vaginal lubrication, irritation and dryness of the external genitalia, vulvovaginitis, local trauma (eg, episiotomy scars), urethritis, improper intromission (angle of entry), anorectal disease, altered anatomy of the female genital tract (eg, a retroverted or prolapsed uterus), and even arthritis.

A general medical and sexual history and a physical and pelvic examination usually uncover the cause. Determining if dyspareunia occurs during foreplay, intromission, deep penetration, or certain positions can help in the differential diagnosis. For example, dyspareunia during deep penetration may indicate lesions of the uterus or broad ligament.

Management involves treatment of the underlying cause. Because dyspareunia is often caused by atrophic vaginitis, a trial of topical estrogen or an estrogen ring is often warranted. Education and guidance in sexual techniques may also be helpful. For example, dyspareunia in a woman with arthritis of the hips may be alleviated if partners lie on their sides ("spoon fashion") rather than with the woman supine during intercourse to reduce weight and pressure on the hips.