Dyspareunia is defined by genital pain experienced before, during, or after intercourse (1), having a significant effect on physical, mental health, and quality of life. The prevalence of dyspareunia varies from 3 to 18% worldwide (2), affecting 10 to 28% of the population in a lifetime (3). 
The aetiology of dyspareunia is multi-factorial, with urological contributors like bladder/pelvic floor dysfunction.  This novel study aims to identify differences in objective urodynamic (UDS) parameters in women with dyspareunia as a secondary symptom. The impact of dyspareunia on urinary symptoms and UDS parameters have not been previously studied.

A retrospective cross-sectional study of women attending UDS at a tertiary centre. 

Inclusion criteria:
Over 18 years
UDS carried out for further assessment of urinary tract symptoms

Exclusion criteria: 
Confirmed diagnosis of endometriosis
Active UTI (as diagnosed by positive urine dip or MSU sent at time of UDS

Women were evaluated with a comprehensive history, use of validated symptom questionnaire, physical examination, urodynamics (flowmetry and dual channel cystometry using air charged catheters with a filling speed of 100 ml / min) and cystoscopy.

Data collected and analysed with SPSS V 26

2, 992 UDS were evaluated, with 1, 264 (42.3%) patients complaining of dyspareunia and 1,728 (57.7%) reporting no dyspareunia. The mean age was 52 years (24-91).

Women with dyspareunia were more likely to present with a great number of lower urinary tract symptoms (mean 5 vs 1), bladder pain (mean 2 vs 1) (p< 0.005), and voiding dysfunction (98%).

Dyspareunia was associated with reduced maximum cystometric capacity (MCC) (480 ml v 503 ml p<0.0005) but no statistical difference in first sensation to void (212 ml v 214 ml). 

Urodynamic stress incontinence (UDSI) and detrusor overactivity (DO) were more frequently diagnosed for women reporting dyspareunia (59% v 54% p<0.005) and (19.8% v 17.1% p<0.005) respectively, and irritative bladder symptoms (83.7% v 62.1 % p <0.005). 

When comparing the cystoscopy findings, women with dyspareunia were interestingly less likely to have bladder trabeculations (7.99% v 10.3 % p<0.05).

The commonly reported associated symptoms in women complaining of dyspareunia were voiding dysfunction, painful bladder, overactive bladder symptoms, nocturia and pelvic organ prolapse respectively. In the women not reporting dyspareunia this was painful bladder, overactive bladder symptoms, nocturia, voiding dysfunction and pelvic organ prolapse.

Dyspareunia as a secondary symptom is associated with reduced MCC and increased diagnoses of UDSI and DO.
Therefore the urodynamics investigation must be tailored to women with dyspareunia who are more likely to complain of bladder pain,  multiple urinary symptoms and voiding dysfunction.

Dyspareunia is common in the urogynaecology population, with varying symptoms including bladder pain and voiding dysfunction.

Binik, Y., Eschenbach, D., WesselmannBinik, Y.M., 2005. Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision. Archives of Sexual Behavior, 34(1), pp.11-21.
Schultz, W.W., Basson, R., Binik, Y., Eschenbach, D., Wesselmann, U. and Van Lankveld, J., 2005. Women's sexual pain and its management. The journal of sexual medicine, 2(3), pp.301-316.
3.	Harlow, B.L., Kunitz, C.G., Nguyen, R.H., Rydell, S.A., Turner, R.M. and MacLehose, R.F., 2014. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. American journal of obstetrics and gynecology, 210(1), pp.40-41.