Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis
1 – Alessandra Graziottin Foundation for the cure and care of pain in women NPO
2 – Center of Gynecology and Medical Sexology, San Raffaele Resnati Hospital, Milan, Italy
Corresponding Author: Alessandra Graziottin
Sexual pain at intercourse, or dyspareunia, is a common symptom affecting up to 1 in 5 women. Despite its high prevalence, sexual pain is still underdiagnosed. When recognized it is poorly characterized in its etiology and consequently undertreated by clinicians, especially when they are not trained in sexual medicine. Sexual pain always has precise biological causes and is often comorbid with other gynecological, pelvic, muscular, urinary, and/ or intestinal pathologies. Correct diagnosis and treatment of sexual pain require collecting a detailed clinical history aimed at identifying the most relevant predisposing, precipitating, and maintenance factors. The goal of the work is to provide the clinician with a questionnaire to make the anamnesis of sexual pain “physician-friendly”, and facilitate the in-depth diagnosis of sexual pain. The clinical reasoning is carefully discussed as well, to guide the reading of the symptoms and signs of the pathologies potentially responsible for sexual pain to identify a tailored multimodal therapy.
Keywords: sexual pain; superficial dyspareunia; deep dyspareunia; clinical history; vulvar pain; endometriosis.
Available in LRIOG Nr.1 – 2022