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Dyspareunia, defined as persistent pain during or after sexual intercourse, is a multifactorial cpndition. The causes of dyspareunia can be broadly categorized into physical, psychological, and situational factors, each contributing to the patient's experience of pain.
| Category | Cause | Description |
|---|---|---|
| Physical Causes | Endometriosis Growth of endometrial tissue outside the uterus | Growth of endometrial tissue outside the uterus causing pelvic pain, dysmenorrhea, and deep dyspareunia. |
| Vulvodynia and Vestibulodynia Chronic pain conditions affecting the vulvar area | Chronic pain or discomfort of the vulvar area leading to superficial dyspareunia. | |
| Vaginal Atrophy Thinning of the vaginal walls due to decreased estrogen levels | Thinning and drying of the vaginal walls due to decreased estrogen levels, common in postmenopausal women, causing pain during intercourse. | |
| Infections | Includes vaginitis, urinary tract infections, yeast infections, and STIs like herpes, causing inflammation and pain during intercourse. | |
| Pelvic Floor Dysfunction | Hypertonic pelvic floor muscles leading to pain during penetration due to muscle spasms or tightness. | |
| Skin Disorders | Conditions such as lichen planus, lichen sclerosus, and psoriasis causing vulvar inflammation and discomfort during sex. | |
| Pelvic Inflammatory Disease | Infection of the upper genital tract causing deep pelvic pain and dyspareunia. | |
| Psychological Factors | Emotional Distress | Stress, anxiety, and depression increasing muscle tension and pain perception during intercourse. |
| History of Trauma | Past sexual abuse or traumatic experiences contributing to pain due to psychological and physiological responses. | |
| Situational Factors | Postpartum Changes | Perineal trauma or anatomical changes after childbirth leading to dyspareunia in the postpartum period. |
| Surgical History | Previous pelvic surgeries like hysterectomy causing scar tissue or changes in anatomy resulting in painful intercourse. | |
| Inadequate Lubrication | Often due to hormonal changes or insufficient arousal, leading to friction and discomfort during sex. |
**References:**
1. **Alimi, Y., Iwanaga, J., Oskouian, R., Loukas, M., & Tubbs, R.** (2018). The clinical anatomy of dyspareunia: a review. *Clinical Anatomy*, **31**(7), 1013-1017. [https://doi.org/10.1002/ca.23250](https://doi.org/10.1002/ca.23250)
2. **Corden, C.** (2013). Causes and management of dyspareunia. *InnovAiT: Education and Inspiration for General Practice*, **6**(2), 66-75. [https://doi.org/10.1177/1755738012470253](https://doi.org/10.1177/1755738012470253)
3. **Eisenberg, V., Weil, C., Chodick, G., & Shalev, V.** (2017). Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. *BJOG: An International Journal of Obstetrics & Gynaecology*, **125**(1), 55-62. [https://doi.org/10.1111/1471-0528.14711](https://doi.org/10.1111/1471-0528.14711)
4. **Farfaras, A., Pierrakos, G., Pateras, I., Skolarikos, P., Wen, S., & Sarris, M.** (2014). Endometriosis: does surgery offer long-term improvement in quality of life? *Journal of Endometriosis and Pelvic Pain Disorders*, **6**(2), 106-111. [https://doi.org/10.5301/je.5000187](https://doi.org/10.5301/je.5000187)
5. **Kj, W., S, I., Joseph, K., Kb, S., & Yong, P.** (2019). Dyspareunia in their own words: a comprehensive qualitative description of endometriosis-associated sexual pain. [https://doi.org/10.1101/19005793](https://doi.org/10.1101/19005793)
6. **Leeners, B., Hengartner, M., Ajdacic-Gross, V., Rössler, W., & Angst, J.** (2015). Dyspareunia in the context of psychopathology, personality traits, and coping resources: results from a prospective longitudinal cohort study from age 30 to 50. *Archives of Sexual Behavior*, **44**(6), 1551-1560. [https://doi.org/10.1007/s10508-014-0395-y](https://doi.org/10.1007/s10508-014-0395-y)
7. **Morris, C., Briggs, C., & Navani, M.** (2021). Dyspareunia. *InnovAiT: Education and Inspiration for General Practice*, **14**(10), 607-614. [https://doi.org/10.1177/17557380211030299](https://doi.org/10.1177/17557380211030299)
8. **Orr, N., Wahl, K., Joannou, A., Hartmann, D., Valle, L., Yong, P., & Renzelli-Cain, R.** (2019). Deep dyspareunia: review of pathophysiology and proposed future research priorities. *Sexual Medicine Reviews*, **8**(1), 3-17. [https://doi.org/10.1016/j.sxmr.2018.12.007](https://doi.org/10.1016/j.sxmr.2018.12.007)
9. **Schnittka, E., Lanpher, N., & Patel, P.** (2022). Postpartum dyspareunia following continuous versus interrupted perineal repair: a systematic review and meta-analysis. *Cureus*. [https://doi.org/10.7759/cureus.29070](https://doi.org/10.7759/cureus.29070)
10. **Streicher, L.** (2023). Diagnosis, causes, and treatment of dyspareunia in postmenopausal women. *Menopause: The Journal of the North American Menopause Society*, **30**(6), 635-649. [https://doi.org/10.1097/gme.0000000000002179](https://doi.org/10.1097/gme.0000000000002179)
11. **Yong, P., Mui, J., Allaire, C., & Williams, C.** (2014). Pelvic floor tenderness in the etiology of superficial dyspareunia. *Journal of Obstetrics and Gynaecology Canada*, **36**(11), 1002-1009. [https://doi.org/10.1016/s1701-2163(15)30414-x](https://doi.org/10.1016/s1701-2163(15)30414-x)
