Dyspareunia

A 45 year old woman presents to her general practitioner with a five year history of painful sex. This had been so severe she has been unable to have intercourse for two years. She complains of being dry and tight, despite using oestrogen vaginal pessaries. She had one child 10 years ago, delivered by caesarean section. She recalled a midwife commenting her vagina was too small during labour. On further questioning she revealed that the problem had become much worse since her husband lost his job three years ago. She expresses concern about the toll this problem is taking on her marriage, and becomes tearful.

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women aged 16-74 years.1 It describes persistent or recurrent pain with attempted or complete vaginal entry or penile-vaginal intercourse.2 Understanding whether the pain is superficial or deep can help to identify its cause.3 Dyspareunia is most common in women aged 55-64 years (10.4%) and those aged 16-24 years (9.5%).1 It is an important and neglected area of female health,45 associated with substantial morbidity and distress. Box 1 includes some comments from women who have experienced the symptoms.