Deep Dyspareunia is usually due to pelvic pathology and the following conditions are commonly encountered.
1 Endometriosis
2 Adenomyosis
3 Acute and Chronic Pelvic Infections
4 Pelvic Congestion Syndrome
5 Adnexal Pathology
6 Retroverted Uterus
7 Residual Ovary Syndrome
8 Interstitial Cystitis
9 Dry Atrophic Tissues
10 Psychosocial Problems
Endometriosis is a condition, the cause of which we do not understand. In spite of lots of research.
In this condition the lining of the uterus can survive outside the uterus, and with each menstrual cycle has some bleed, as a result of that , some scar tissue forms. Often the blood collects and forms cysts of varying sizes. This can happen at any age group. The main symptom is painful periods, abdominal discomfort, pain on defecation and deep dyspareunia. We talked about clinical history in examination in previous posts but if you are looking for the cause of deep dyspareunia it is important to have an ultrasound and an MRI, so that diagnosis of some of the other conditions can be made.
Endometriosis also causes infertility, the definitive diagnosis is established by a surgical procedure called Laparoscopy, which in simple words mean Key Hole surgery of peeping in the belly.When Endometrios is minor it appears as dark spots which can be lasered or diathermy and this gives relief to the patient. This should be followed by oral contraception, so that the periods are small or none. With this treatment, the chances of endometriosis recurring are minimised. This often helps the women to get pregnant if they were having difficulty.
during Laparoscopy.
Endometriosis grows under the influence of hormone oestrogen, therefore it grows during reproductive years. It eases off during pregnancy and after menopause. It is a painful condition, the main treatment needs to suppress oestrogens which can be done by many drugs, the simplest being Progesterone and continuous oral contraceptive pill.
The other part of the treatment is pain relief, and this can be done by non steroidal antinflammatory drugs.
If the endometriosis is advanced and has made large cysts , they have to be surgically removed, either by key hole surgery or open surgery. The largest endometriosis I have removed were about the size of two cantaloupes , one on each ovary.
For what ever reason this patient had no pain. The diagnosis was made by Ultrasound.
The youngest patient of endometriosis I have treated with laparoscopic diathermy was thirteen years of age. I was a bit reluctant to do this , but her mother assured me that her pain was very severe and I had to do something.
Endometriosis in itself is a very large topic and needs an individual post which I will do at a later date. But for now, you can remember that this is one of the main causes of Deep Dyspareunia.
Adenomyosis is similar to Endometriosis and here the endometrial implants are within the muscle of the uterus. Month after month there is small bleeding within the muscles of the uterus, as a result the uterus enlarges in size and the patient has heavy and painful periods. She feels as if there is a lump in her belly. When the uterus becomes enlarged it falls backwards, what is called retroverted uterus. This cause chronic pelvic pain and deep dyspareunia. This can also cause pelvic congestion adding to the symptoms. Adenomyosis until recent times was ignored as there were no definitive diagnostic criteria. Recently with the help of colour ultrasound and MRI it has become easy.
There is no definite cure for adenomyosis but we suppress the oestrogens with the pill, intrauterine device called Mirena. The cure is hysterectomy in older women, who do not desire any children and a definitive diagnosis is made when the uterus is in your hand.
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