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Evaluation of Genito-Pelvic Pain/Penetration Disorder

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The Textbook of Clinical Sexual Medicine

Abstract

Pain during intercourse (coital pain or “dyspareunia”) has been recently included under the new genito-pelvic pain/penetration disorder (GPPPD). With patients, “pain during intercourse” is the best wording to ease communication. GPPPD is a sexual disorder with a multifactorial etiology. It can be elicited at the entrance of the vagina (“introital dyspareunia”), deep in the vagina (“deep dyspareunia”), or both. In its comprehensive wording, it should include pain during anal intercourse (when women like/practice it) and clitoral pain during penetration and/or at orgasm. Leading etiologies are different among premenopausal and postmenopausal women. In premenopausal subjects, the most frequent biological etiologies of introital dyspareunia are vulvar vestibulitis/provoked vestibulodynia, with recurrent candida infections and/or an hyperactive pelvic floor in the background, and painful outcomes of delivery (either because of episiotomy/rraphy, or traumatic deliveries). Endometriosis, chronic pelvic pain, and pelvic inflammatory disease are leading contributors of deep dyspareunia in premenopausal subjects.

In postmenopausal women, vaginal dryness and vulvovaginal dystrophy are leading etiological factors of introital dyspareunia, and may concur to deep dyspareunia, with iatrogenic factors such as surgical shortening of the vagina and/or radiotherapy contributing to deep sexual pain. Neuropathic pain may contribute to GPPPD, independently of the woman’s age, hormonal status, and etiology of her coital pain. Frequent comorbidities of GPPPD include postcoital cystitis (in 60% of patients), irritable bowel syndrome (IBS) and endometriosis. Biological, psychosexual, and contextual factors, predisposing, precipitating, and/or perpetuating pain, should be carefully evaluated by the physician to describe the pathophysiologic scenario and design the best treatment, individually tailored.

The chapter addresses the key diagnostic steps in the history taking, with an accurate reporting of women’s wording, and in the physical examination, cornerstone of the proper diagnosis and yet still dramatically neglected in the clinical practice. Instrumental exams are briefly described to complete the evaluation process.

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Authors and Affiliations

  1. Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan, Italy

    Alessandra Graziottin

  2. Department of Gynecology and Obstetrics, San Raffaele Hospital Milan, Milano, Italy

    Dania Gambini

Authors
  1. Alessandra Graziottin
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  2. Dania Gambini
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Correspondence to Alessandra Graziottin .

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Editors and Affiliations

  1. Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Waguih William IsHak

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Graziottin, A., Gambini, D. (2017). Evaluation of Genito-Pelvic Pain/Penetration Disorder. In: IsHak, W. (eds) The Textbook of Clinical Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-52539-6_20

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  • DOI: https://doi.org/10.1007/978-3-319-52539-6_20

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  • Publisher Name: Springer, Cham

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