An interdisciplinary approach that includes gynecological treatment, pain education, physical therapy and psychotherapy could benefit women with deep dyspareunia, suggests a new study.
Dyspareunia is the medical term for painful intercourse. It is usually described as superficial (mainly affecting the entrance of the vagina) or deep (occurring with deep penetration).
Deep dyspareunia can have a number of causes, such as pelvic floor dysfunction and interstitial cystitis/painful bladder syndrome. It is thought to affect about half of women with endometriosis.
For the current study, researchers analyzed information from 278 women (average age 35) with deep dyspareunia. At baseline, and again at a one-year follow-up point, the women rated the severity of their dyspareunia on a scale of 0-10, with scores of 0-3 points representing absent or mild dyspareunia, 4-6 points signifying moderate dyspareunia, and 7-10 points indicating severe dyspareunia.
The women were also assessed for comorbidities, depression, anxiety, and sexual quality of life at these time points.
At the researchers’ clinic, deep dyspareunia was addressed with an interdisciplinary approach that included minimally invasive surgery, hormone therapy, pain education, physiotherapy, or psychological therapy. Physicians and patients decided which components to use or combine.
At baseline, about 28% of the women fell into the absent/mild category. Seventeen percent rated their dyspareunia as moderate, and 55% said it was severe.
At the one-year follow up, these rates had improved, with 45%, 25%, and 30% reporting absent/mild, moderate, and severe dyspareunia, respectively.
Sexual quality of life also improved. The researchers based this finding on the sex subscale of the Endometriosis Health Profile-30, which includes questions on pain, guilt, frustration, worry, and avoidance related to sexual activity. Higher scores on this tool indicates worse sexual quality of life. At the start of the study, the women’s mean score on this tool was 56%; after one year, it had dropped to 43%.
Depression and younger age were considered predictors for persistent deep dyspareunia after one year. Depression can affect the sexual response cycle, pelvic floor function, relationships with partners, and emotional aspects of pain, the authors noted.
“Further work is needed to elucidate the role of depression in deep dyspareunia, and to determine the ideal treatment of depression in this context (psychological, pharmacological, or a combination),” the authors wrote.
They added that younger women may be more symptomatic and request treatment earlier.
Because treatments were tailored to patients, it was not clear which types of interventions brought about the best results. The authors recommended further research in this area.
They recommended that interdisciplinary care for deep dyspareunia receive “greater recognition” and further study. They also suggested that patients be screened for depression, as addressing depression might reduce the need for other treatments.
The study was published online in November in the Journal of Sexual Medicine.
“Does interdisciplinary care improve deep dyspareunia treatment?”
(December 11, 2018)
The Journal of Sexual Medicine
Yong, Paul J., MD, PhD, et al.
“Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting”
(Full-text. Published online: November 13, 2018)