Dyspareunia

Painful intercourse can be considered as superficial (pain felt on insertion) or deep (pain on deep penetration).

Causes of superficial dyspareunia:

• physiological—inadequate lubrication

• provoked vestibulodynia syndrome (vestibular hypersensitivity, 489)

• vaginitis, esp. chronic candidiasis

• vulvar dermatoses

• postnatal perineal scarring

• vulvovaginal atrophy

• incompletely ruptured hymen

• vaginismus

Causes of deep dyspareunia:

• endometriosis

• PID

• pelvic adhesions

• ovarian and uterine tumours

Management involves treating the organic cause and advice about use of lubricants, including topical oestrogen where indicated.