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Journal article
Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities
Sexual medicine reviews, v 8(1), pp 3-17
01 Jan 2020
PMID: 30928249
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction: Dyspareunia has been traditionally divided into superficial (introital) dyspareunia and deep dyspareunia (pain with deep penetration). While deep dyspareunia can coexist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep dyspareunia.
Aims: To review the pathophysiology of deep dyspareunia, and to propose future research priorities.
Methods: A narrative review after appraisal of published frameworks and literature search with the terms (dyspareunia AND endometriosis), (dyspareunia AND deep), (dyspareunia AND (pathophysiology OR etiology)).
Main Outcome Variable: Deep dyspareunia (present/absent or along a pain severity scale).
Results: The narrative review demonstrates potential etiologies for deep dyspareunia, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders. These etiologies can be classified according to anatomic mechanism, such as contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration. Etiologies of deep dyspareunia can also be stratified into 4 categories, as previously proposed for endometriosis specifically, to personalize management: type I (primarily gynecologic), type II (non-gynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed). We also identified gaps in the literature, such as lack of a validated patient-reported questionnaire or an objective measurement tool for deep dyspareunia and clinical trials not powered for sexual outcomes.
Conclusion: We propose the following research priorities for deep dyspareunia: deep dyspareunia measurement tools, inclusion of the population avoiding intercourse due to deep dyspareunia, nongynecologic conditions in the generation of deep dyspareunia, exploration of sociocultural factors, clinical trials with adequate power for deep dyspareunia outcomes, partner variables, female sexual response, pathways between psychological factors and deep dyspareunia, and personalized approaches to deep dyspareunia. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
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Details
- Title
- Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities
- Creators
- Natasha Orr - Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada.Kate Wahl - University of British ColumbiaAngela Joannou - EndometriosisDee Hartmann - American Physical Therapy AssociationLisa Valle - Oasis Women's Sexual Function Center, Santa Monica, CA, USA.Paul Yong - University of British ColumbiaCorey Babb - Oklahoma State Univ, Ctr Hlth Sci, Tulsa, OK USACatherine W. Kramer - Women First Rehab, Woodstock, GA USASusan Kellogg-Spadt - Drexel UniversityRoberta Renzelli-Cain - West Virginia Univ, Sch Med, Morgantown, WV 26506 USASpecial Interest Grp Sexual Pain
- Publication Details
- Sexual medicine reviews, v 8(1), pp 3-17
- Publisher
- Elsevier
- Number of pages
- 15
- Grant note
- Health Professional Investigator Award of the Michael Smith Foundation for Health Research
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Obstetrics and Gynecology
- Web of Science ID
- WOS:000508833400002
- Scopus ID
- 2-s2.0-85063378714
- Other Identifier
- 991019167535804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Urology & Nephrology