Hypothesis / aims of study
Dyspareunia is persistent, recurrent pain or discomfort associated with attempting or performing vaginal penetration [1]. It is one of the most commonly reported sexual dysfunction to professionals. Overall, up to 50% of women report sexual problems to a gynecologist, but only one-fifth consistently seek medical help [2]. Knowledge and understanding of the factors related to the decision-making of women with dyspareunia and the obstacles that prevent them from receiving treatment are related to taking appropriate action to ensure access to proper diagnosis and treatment, thus improving the quality of sexual life in women with sexual dysfunctions.
The descriptive study aimed to evaluate the feedback women with painful intercourse have received from their gynecologist; to analyze women's attitude to the problem of painful intercourse, the help-seeking behavior, reporting the issue to a specialist, undertaking treatment for the dysfunction.
Study design, materials and methods
Twelve women aged 21 to 35 years who completed an anonymous survey and the Female Sexual Function Index (FSFI) were included. A sample of 12 women among 80 respondents with dyspareunia was selected for qualitative assessment. Inclusion criteria were: age over 18, history of dyspareunia, reporting the problem to a gynecologist, not being pregnant.
The survey included questions about the perception of dyspareunia: whether it is an embarrassing issue for the respondents and whether it is a dysfunction in their opinion. Respondents were asked about the frequency of intercourse, the pain level in the Numerical Rating Scale (NRS), if they reported the issue to specialists: gynecologists or physiotherapists, if they made any attempts to cure painful intercourse, and also if the diagnosis was made and what opinion was given to them by the gynecologist during the consultation. The responses were divided into subtypes: positive, negative, and neutral – depending on the usefulness of the information the professional provided to the respondents and whether it involved introducing an appropriate treatment.
The demographic data, questionnaire scores, and descriptive responses were analyzed. The FSFI, consisting of desire, arousal, lubrication, orgasm, sexual satisfaction, and pain domains, was used to assess the subjects' sexual function. A score of ≤26.55 was the cut-off point for significant clinical sexual dysfunction.
Results
The mean age and body mass index of the study participants was 25.75±3.9 and 22.5±4.6, respectively. Ten (83.3%) women had high education, and 2(16.7%) had secondary education. Most of them – 9(75%) lived in a city with more than 100 thousand inhabitants, 2(16.7%) in a city with 50-100 thousand inhabitants, and 1(8.3%) in a city with less than 50 thousand inhabitants.
Three (25%) subjects engaged in intercourse at least once a month, 5(41.7%) at least once a week, and 4(33.3%) several times a week. Pain experienced by women during intercourse according to the NRS scale was mean 6.8±2.1, and 11(91.7%) of all subjects reported pain NRS ≥5. The mean FSFI score was 25.88±4.57, and 6(50%) subjects scored ≤26.55. Women with dyspareunia received the lowest score in the pain domain (mean 3±1.3), and they performed best in the sexual satisfaction domain (mean 5.2±0.98).
Dyspareunia was regarded as a disorder by 10(83.3%) respondents, and 8(66.7%) described it as an embarrassing problem. According to half of the respondents, dyspareunia had a negative effect on their relationship with their partner. Among women who reported the problem to a gynecologist, only 3(25%) sought help from a physiotherapist.
After consultation and examination by a gynecologist, 7(58.3%) women received a diagnosis that could suggest the cause of the reported dyspareunia, while 5(41.7%) did not receive any diagnosis for the reported issue. Figure 1 shows the diagnoses obtained by the patients. However, the opinions of gynecologists were not always helpful, and could even be negative and demotivating as shown in Figure 2. As a consequence, patients undertook various types of treatment or interventions: changing sexual position – 10(83.3%), local lubrication – 10(83.3%), pharmacological – 4(33 3%), physiotherapeutic – 3(25%), psychological – 2(16.7%), surgical – 2(16.7%).
Interpretation of results
Dyspareunia is a significant problem that warrants seeking help from specialists. In fact, there is no research on help-seeking behavior for painful intercourse in Poland. It was evident that women were unanimous that painful intercourse is not physiological. The study results showed that women with dyspareunia who sought help from specialists experienced significant pain (at least 5 in the NRS). If they decided to seek help, they consulted a gynecologist, and few of them used the opportunity to visit a physiotherapist. Only a few of them received a diagnosis that could indicate the cause of their ailments. Some of them met with inadequate treatment and devaluation of their issue. Thus, some of the subjects not only did not receive appropriate help but were stuck in a diagnostic blind spot or, perhaps, discouraged from further exploration because of unprofessional treatment by the gynecologist they trusted. Women have undertaken a variety of interventions to alleviate pain. However, some of these interventions, such as topical lube or changing sexual position (the most commonly used), are only temporary relief and symptomatic treatment rather than systemic causal treatment.