British Study Sheds Light on Postmenopausal Dyspareunia

Dyspareunia is a common female health problem, according to a large British population probability survey published in 2017, affecting 7.5% of sexually active women. However, it often is neglected by healthcare providers due to difficulties in diagnosing and treating the condition.

The survey was conducted between September 2010 and August 2012, and 8,869 women aged 16-74 years were interviewed in their homes (face to face with researchers via computer as well as by self-interview for questions of a more intimate nature). Women were asked whether they had experienced problems with their sex lives lasting ≥ 3 months in the past year. In addition to dyspareunia, they were asked about:

• disinterest in sex,

• lack of enjoyment of sex,

• anxiety during sex,

• lack of excitement or arousal during sex,

• problems experiencing orgasm (anorgasmia, delay in orgasm or reaching orgasm too quickly), and

• vaginal dryness.

Subjects who replied positively to the dyspareunia question were asked how long and how often she had been experiencing painful sex and how they felt about it. Women who had been experiencing dyspareunia for ≥ 6 months with frequent symptoms and were distressed about it were categorized as having “morbid pain.”

Further inquiries were made to women who reported they were not sexually active, asking if they had avoided sex due to dyspareunia.

Results Confirm Previous Surveys

The overall prevalence of dyspareunia for all women in this survey was 7.5%, which is slightly less than but in keeping with previous surveys. Fewer than 2% of women met all three criteria for morbid pain; 4.6% met one or two criteria for morbid pain. When analyzed by age, women aged 16 to 24 and 55 to 64 were most likely to report dyspareunia. Women aged 55 to 64 had the highest prevalence (3.9%) of morbid dyspareunia.

Of the women who were not sexually active (n = 1,505) and responded to the question on whether they avoided sex because of sexual issues, 211 answered affirmatively and 35 of them reported dyspareunia or the fear of dyspareunia as the reason.

In this survey, dyspareunia was strongly associated with other sexual difficulties, such as lack of libido (62%), vaginal dryness (45.2%), problems experiencing orgasm (40.2%), and lack of enjoyment of sex (40.1%). A third (30.9%) of women with dyspareunia were dissatisfied with their sex lives and 28.9% were distressed or worried about their sex lives. Women with dyspareunia were also much more likely to have avoided sex in the past year due to sexual difficulties, reported the authors.

When the results were adjusted for age, dyspareunia was associated with factors such as higher educational status and retirement. Poor health, postmenopausal status, past sexually transmitted infection, and sexual abuse or rape were also strongly associated with painful sex. In regard to relationship factors, no associations were found between number of sexual partners in the last year, frequency of intercourse, or relationship status, duration, or satisfaction and dyspareunia. Painful sex was, however, strongly associated with imbalances in sexual interest and likes and dislikes between sexual partners, and sexual difficulties of partners. Women who reported dyspareunia were also found to be uneasy about discussing sex with their partners and tended to agree that men had stronger sex drives than women.

Holistic Approach to Assessment Advised

Noting that etiology and underlying conditions behind dyspareunia are complex, poorly comprehended, and difficult to diagnose and treat, the researchers suggested that overlooking or poorly managing dyspareunia can significantly exacerbate a patient’s level of distress. Indeed, they stated that dyspareunia is more distressing to women than more commonly reported issues such as lack of libido or anorgasmia, and can lead to “feelings of isolation, shame, sexual inadequacy, loss of confidence and feeling out of control.” The researchers therefore suggested that healthcare providers be conscientious in incorporating questions and education about dyspareunia into routine discussions with female patients.