Postmenopausal Dyspareunia

Recurrent pain during intercourse occurring for the first time within or subsequent to the menopausal transition is typically attributed to vulvovaginal and urogenital atrophy (also referred to as atrophic vaginitis) (83). These conditions are manifestations of tissue aging, cytological changes, and chemical transformations within the vagina, urethra, and bladder, which result from declining levels of endogenously produced estrogens at menopause (84,85). Both the DSM-IV-TR (3) and the ICD-10 (4) specifically mention this problem but do not classify it as dyspareunia. In the DSM-IV-TR, it would be termed a "sexual dysfunction due to a general medical condition," whereas in the ICD-10, it is classified as "postmenopausal atrophic vaginitis." These classifications and descriptions appear to be based on clinical experience since there is, in fact, very little systematic research evidence to support a strong link between declining estrogen levels, vulvovaginal atrophy, and recurrent pain during intercourse (86-88).

Comment

Regardless of etiology, many areas of these women's lives must be addressed simultaneously in order to achieve therapeutic success. Once the pain is consistently present, a vicious cycle is put into motion (Fig. 10.2), involving physical, muscular, psychological, sexual, and relationship factors.

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