Deep dyspareunia: a narrative review of impact on sexual function and quality of life

Deep dyspareunia refers to pain with deep penetration or insertion into the vagina, which affects quality of life. The aim of this narrative review was to examine how the underlying conditions that give rise to deep dyspareunia, and the symptoms of these conditions, can affect sexual function and quality of life beyond the deep dyspareunia itself. For example, deep dyspareunia may be associated with gynecological pathologies that cause cyclical pain symptoms (e.g. dysmenorrhea, dyschezia/dysuria), resulting in quality of life changes related to menstrual cycle events such as ovulation or menstruation. Recurrent dysmenorrhea can cause hyperalgesic priming that sensitizes the nervous system, leading to chronic pelvic pain that can be exacerbated with sexual activity. The coexistence of functional bowel or bladder disorders can result in urgency and frequency that affect the sexual response cycle. Myofascial/musculoskeletal origins of deep dyspareunia may affect body positioning during sexual activity. Central nervous system sensitization can underlie these different factors, and also be associated with mental health conditions, which together can cause symptomatology across body systems that can affect all aspects of one's sexual life. Recognition and management of the far-reaching impacts of deep dyspareunia and its associated comorbidities may be important in clinical care to meaningfully improve quality of life. Future research should include a comprehensive empirical validation of the hypotheses and potential mechanisms in this review.