October 2014

Dyspareunia

Presented by: Hilary Liddell

Date: Wednesday 22nd October 2014

October 2014

Dyspareunia

• Distress• Dissatisfaction

October 2014

1. Superficial – Introital

2. Deep - Pelvic

October 2014

History• Young – Peripartum – Older• Superficial

• Onset• Candidiasis – Treatment• Discharge• Oestrogen Deficiency• Tampon Insertion• Relationship Difficulties• Sexual abuse

• Deep – Other Pelvic Pain

Take a look

October 2014

Examination

Demeanor - Hyperaesthesia Vulval lesions – fissures Vaginal discharge – STD swabs Vaginismus Swab tenderness 4 & 8 Uterine + P.O.D. tenderness Masses

October 2014

Deep

• Endometriosis– Retroversion– P.O.D. disease

• Adenomyosis• P.I.D.• Adnexal mass

October 2014

Superficial Vestibulodynia

• Skin type• Antibiotics

– Candidiasis• Topical Antifungals• Hyperaesthesia – Chronic Pain Syndrome• Sexual Dysfunction

October 2014

Sexual Problems

• Lack of Arousal• Lack of Protective Physiological Response• Avoidance I/C• Increased local trauma / pain

October 2014

Local Trauma (Candidiasis)

The Vicious Cycle

October 2014

Treatment - Multifactorial• Skin care

• Avoidance soap, topical antifungals• Cotton• Not shaving

• Pinetarsol, other soap substitutes• Lubricants• Oral antifungals• Vaginal dilators• Sexual Counselling• Physiotherapy

October 2014

Woodruffs Repair

Thank you