october 2014 dyspareunia presented by: hilary liddell date: wednesday 22 nd october 2014
TRANSCRIPT
October 2014
History• Young – Peripartum – Older• Superficial
• Onset• Candidiasis – Treatment• Discharge• Oestrogen Deficiency• Tampon Insertion• Relationship Difficulties• Sexual abuse
• Deep – Other Pelvic Pain
October 2014
Examination
Demeanor - Hyperaesthesia Vulval lesions – fissures Vaginal discharge – STD swabs Vaginismus Swab tenderness 4 & 8 Uterine + P.O.D. tenderness Masses
October 2014
Superficial Vestibulodynia
• Skin type• Antibiotics
– Candidiasis• Topical Antifungals• Hyperaesthesia – Chronic Pain Syndrome• Sexual Dysfunction
October 2014
Sexual Problems
• Lack of Arousal• Lack of Protective Physiological Response• Avoidance I/C• Increased local trauma / pain
October 2014
Treatment - Multifactorial• Skin care
• Avoidance soap, topical antifungals• Cotton• Not shaving
• Pinetarsol, other soap substitutes• Lubricants• Oral antifungals• Vaginal dilators• Sexual Counselling• Physiotherapy