Intended for healthcare professionals

Rapid response to:

Practice Practice Pointer


BMJ 2018; 361 doi: (Published 19 June 2018) Cite this as: BMJ 2018;361:k2341

Rapid Response:

Re: Dyspareunia

Thank you for your article. Sadly women with dyspareunia continue to be overlooked, resulting in a delay in treatment and in some cases no appropriate treatment being offered at all. Whilst we agree the numbers of women seen with dyspareunia are significant and the approach to their management needs to be holistic to ensure that both the underlying cause is identified, additionally many women who may start with an organic cause for dyspareunia develop a psychosocial aspect, and this indeed must be recognised and addressed.

Furthermore, we feel that during your article you did not focus on history taking for relevant events that may identify the potential cause of dyspareunia, such as deep and extensive lateral wall tears occurring during labour that may have caused scarring and subsequent pain, or even with a history of caesarean section, where a deep angle extension may consequently cause dyspareunia.

Additionally, a history of treatment of deep infiltrating endometriosis may suggest recurrence of the endometriosis or formation of scar tissue, again accounting for dyspareunia. As 68% of women with endometriosis report symptoms of dysmenorrhoea and 42% report dyspareunia.

There appears to be no discussion on gynaecological or surgical management options in cases when there are physical or structural findings. Should scarring exist towards the introitus, the removal of scar tissue will alleviate superficial dyspareunia.

Also if there is a decreased stretchability of the posterior fourchette from fissures or micro/macro tears, atrophy, previous episiotomy procedures or surgery in the vulval regions. This can result in central introital dyspareunia (CID). This may require a fenton’s repair.

It must be recognised that there are a substantial number of organic causes of dyspareunia that must be excluded, with a detailed history and appropriate examination before a diagnosis of psychosexual dyspareunia is made.

Competing interests: No competing interests

12 July 2018
Stewart Disu
Consultant Gynaecologist
A.Abdullah Specialist Registrar (ST7) / R.Laiyemo - Consultant Gynaecologist / F.A Sanusi -Consultant Gynaecologist
London North West University Healthcare NHS Trust