Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

Paul J Yong; Christina Williams; Ali Yosef; Fontayne Wong; Mohamed A Bedaiwy; Sarka Lisonkova; Catherine Allaire

doi:10.1016/j.esxm.2017.07.001

Sexual Health Sexual Pain

Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

Yong PJ, Williams C, Yosef A, Wong F, Bedaiwy MA, Lisonkova S, Allaire C

Published September 2017 Sexual medicine

DOI 10.1016/j.esxm.2017.07.001 PMID 28778678 PMC PMC5562494

RRM Academy Synopsis

Deep dyspareunia severity is linked to tenderness at four pelvic sites

In 548 referral-center women, deep dyspareunia was worse when any of four pelvic sites was tender. Deep dyspareunia is pain during deep penetration. The sites were the bladder, the cervix and uterus, the pelvic floor, and the cul-de-sac and uterosacral ligaments. This cross-sectional Canadian study found more tender sites went with worse pain. The adnexa showed no independent link.

About 6 in 10 women at a referral center had tenderness at the cul-de-sac or uterosacral ligaments. Source: Yong PJ et al., 2017, PMID 28778678.

Study at a glance, cross-sectional Canadian study: Deep dyspareunia was worse when any of four pelvic sites was tender — Study at a glance, cross-sectional Canadian study of 548 referral-center women: Deep dyspareunia was worse when any of four pelvic sites was tender. Source: Yong PJ et al., 2017, PMID 28778678.

Key Findings

The bladder was tender in 19% (102 of 548) of the women, and the cul-de-sac or uterosacral ligaments in 57% (313 of 548).
Independent links with severity on the 0 to 10 scale: bladder b = 0.88 (0.15 to 1.60); b = 1.39 (95% CI 0.85 to 1.93) at the cul-de-sac or uterosacral ligaments.
Cervix and uterus tenderness (P = .008) and pelvic floor tenderness (b = 0.66, 0.04 to 1.28) also had independent links. Adnexa tenderness did not.
The number of tender sites rose with pain severity: Spearman r = 0.34, P < .001, so women with more tender sites reported worse deep dyspareunia.
Miscarriage history tied to a tender cervix and uterus (odds ratio 2.24, 95% CI 1.42 to 3.53). Endometriosis present versus excluded tied to tender cul-de-sac or uterosacral ligaments (3.54, 2.00 to 6.25).

Interpretation

The authors note that depression can result from deep dyspareunia as well as contribute to it. The findings support larger studies of how tenderness at these pelvic sites relates to deep dyspareunia severity.

RRM Context

Restorative reproductive medicine starts by asking what causes the pain. The authors report that excision of endometriosis at the cul-de-sac or uterosacral ligaments can be a treatment for deep dyspareunia. They add that pain persisting after surgery calls for checking the other sites. Endometriosis was tied to tenderness at just one of the four sites. A root-cause approach keeps evaluating after the first diagnosis.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Deep dyspareunia negatively affects women's sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population.

Aim

To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center.

Methods

This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site.

Main Outcome Measures

Severity of deep dyspareunia on a numeric pain rating scale of 0 to 10.

Results

Severity of deep dyspareunia (scale = 0-10) was independently associated with tenderness of the bladder (b = 0.88, P = .018), pelvic floor (levator ani) (b = 0.66, P = .038), cervix and uterus (b = 0.88, P = .008), and cul-de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = -0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P < .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P = .008) and pelvic floor (b = 1.07, P < .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P = .001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b = 3.54, P < .001).

Conclusions

In reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the bladder, pelvic floor, and cervix and uterus. Yong PJ, Williams C, Yosef A, et al. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017;5:e184-e195.

Topics

Sexual Health › Sexual Pain › Dyspareunia · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Paul J Yong, Christina Williams, Ali Yosef, Fontayne Wong, Mohamed A Bedaiwy, Sarka Lisonkova, Catherine Allaire

P Yong, C Williams, A Yosef, F Wong, M Bedaiwy, S Lisonkova, Cathy Allaire, Kate Allaire, C Allaire

PMID 28778678 28778678 DOI 10.1016/j.esxm.2017.07.001 10.1016/j.esxm.2017.07.001 Yong et al. 2017, Yong 2017

Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

Deep dyspareunia severity is linked to tenderness at four pelvic sites

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research