Primary care

10-minute consultation BMJ: first published as 10.1136/bmj.328.7452.1357 on 3 June 2004. Downloaded from Female dyspareunia Liz Ryan, Keith Hawton

This is part of A 30 year old woman tells you she has experienced Useful reading pain during sexual intercourse since the birth of her a series of first baby a year ago. She has now lost interest in sex. Binik YM, Bergeron S, Khalifé S. Dyspareunia. In occasional Her husband is becoming impatient, and she asks you Leiblum SR, Rosen RC, eds. Principles and Practice articles on for help. of Sex Therapy. 3rd ed. New York: Guilford Press, common 2000:154-80 problems in primary care What issues you should cover Dean J. ABC of sexual health: examination of patients with sexual problems. BMJ Alec Turnbull Ask about the nature of the pain—When and where 1998;317:1641-3 Clinic, East Oxford does she feel the pain? Is it near the vaginal entrance Health Centre, Oxford OX4 1XD on initial penetration or is it felt more deeply on Graziottin A. Clinical approach to dyspareunia. J Sex Marital Ther 2001;27:489-501 Liz Ryan thrusting? Does she have any other abdominal pains? family planning Does she feel that she is “too tight” to allow doctor and penetration? The dyspareunia may be accompanied by Hawton K. Sex therapy: a practical guide. Oxford: psychosexual therapist vaginismus. Does she experience pain every time she Oxford University Press, 1985 Warneford Hospital, Oxford attempts intercourse? If not, what is different about the Ramage M. ABC of sexual problems: management OX3 7JX times when she doesn’t have pain? Is she more relaxed, of sexual problems. BMJ 1998;317:1509-12 Keith Hawton and if so why? professor of psychiatry and consultant Other symptoms—Does she have a vaginal discharge? psychiatrist This may indicate infection or other pathology. Is she x If you think relationship difficulties are an Correspondence to: depressed? important factor, talking through them with her may Keith Hawton Sex before she had the baby—Was intercourse keith.hawton@ encourage her to talk to her husband and try to resolve previously free of pain, and did she enjoy sex? How did psychiatry.ox.ac.uk them. You could recommend that they see a couples the pregnancy affect sex? This series is edited counsellor in the practice or at Relate. The delivery—Was there trauma? Did she have a tear by general x A penetration desensitisation programme, in which practitioners Ann or episiotomy? If so, does she feel confident that it McPherson and she is encouraged to insert one finger, then two, then healed well? Did she examine herself after the birth to Deborah Waller http://www.bmj.com/ three into her vagina, while relaxing the lower vaginal (ann.mcpherson@ ascertain when penetration might be painless? Are muscles, can be very effective for dyspareunia and dphpc.ox.ac.uk) there other issues about the birth? vaginismus. Clear instructions and regular follow up The BMJ welcomes Foreplay and non-penetrative sexual behaviour—Is she are vital for success. contributions from becoming aroused and lubricating? Lubrication and general practitioners x If psychosexual problems persist refer her to a psy- expansion of the upper vagina occur only with arousal. to the series chosexual therapist at your local family planning clinic, Does she reach orgasm? Relate, or a sexual problems clinic. Her partner should BMJ 2004;328:1357 Her relationship—Has her relationship with her

usually be involved at this stage, if you have not already on 1 October 2021 by guest. Protected copyright. partner changed since the birth? If so, how? Do they seen them together. The British Association for Sexual find time to enjoy themselves as a couple? Are they and Relationship Therapy can recommend private affectionate? Do they find it difficult to switch roles therapists. from parents to lovers? Is she concerned about her pain and her loss of interest in sex, or is it just her hus- band who views it as a problem? Resources for patients Feelings about becoming a parent—Ask her what becoming parents has meant to them both. Was the Self help books pregnancy planned? Does the baby sleep in their bed- Litvinoff, S. The Relate guide to sex in loving relationships. room? If so, how do they feel about this? Is she using London: Vermilion, 1992 contraception, and does she trust it? Is she still breast Litvinoff, S. The Relate guide to better relationships. feeding? London: Vermilion, 1992 Sources of help British Association for Sexual and Relationship Therapy, PO Box 13686, London SW20 9ZH (tel 020 What you should do 8543 2707; www.basrt.org.uk) x Do an abdominal and vaginal examination to Relate (national office), Herbert Gray College, Little exclude a physical cause. Church Street Rugby CV21 3AP (tel 01788 573241; x If psychological issues connected with the birth are www.relate.org.uk) important, she may wish to discuss these with a British Association for Counselling and counsellor. The British Association for Counselling Psychotherapy, 1 Regents Place, Rugby CV21 2PG (tel and Psychotherapy will provide a list of local 01788 550899; www.counselling.co.uk) counsellors.

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