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Where does postmenopausal dyspareunia hurt? A cross-sectional report.
Martha F Goetsch1, Bharti Garg1, Jen Lillemon2
1Department of ObGyn, Oregon Health and Science University, Portland, OR.
Menopause (New York, N.Y.)
|March 1, 2022
Summary
Dyspareunia, a common symptom of genitourinary syndrome of menopause (GSM), is often linked to vulvovaginal atrophy. This study found tenderness most severe at the vulvar vestibule, suggesting a key area for treatment focus in GSM patients.
Area of Science:
- Gynecology
- Menopause Research
- Pain Management
Background:
- Dyspareunia, or painful intercourse, is a prevalent symptom of genitourinary syndrome of menopause (GSM).
- This condition is frequently attributed to vulvovaginal atrophy, characterized by changes in the vaginal and vulvar tissues.
- Understanding the specific pain characteristics and anatomical locations is crucial for effective management.
Purpose of the Study:
- To systematically describe the pain characteristics and anatomical locations of tenderness in women experiencing moderate to severe dyspareunia due to GSM.
- To provide baseline data for an intervention trial involving topical estrogen therapy.
Main Methods:
- A cross-sectional study involving postmenopausal women with moderate/severe dyspareunia not using hormone therapy.
- Biopsychosocial assessments using the Vulvar Pain Assessment Questionnaire.
- Systematic vulvovaginal examination including visual assessment, cotton swab testing for tenderness (0-10 scale), vaginal pH, mucosal sensitivity, and palpation of pelvic floor muscles and viscera.
Main Results:
- Fifty-five women (mean age 59.5 years) with a mean dyspareunia duration of 6.2 years participated.
- The mean intercourse pain score was 7.3/10, commonly described as "burning" and "raw."
- Ninety-eight percent showed physical signs of vulvovaginal atrophy, with maximal tenderness (median 4-5/10) at the vulvar vestibule; topical lidocaine relieved this pain, while vaginal mucosal pain was minimal (median 0/10).
Conclusions:
- Pain in dyspareunia associated with GSM is predominantly characterized by burning and dryness.
- Tenderness is most consistently and severely located at the vulvar vestibule.
- Correlating dyspareunia symptoms with specific genital examination findings can enhance understanding of treatment efficacy for GSM.
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