Q&A: Painful Sexual Intercourse in a Woman

Female sexual pain (FSP) has a significant negative impact on a woman's health, self-esteem, relationships, quality of life, and work productivity. It is unclear if sexual pain is a sexual disorder, pain disorder, or both. It can be difficult to identify a definitive cause of pain. Etiologies range from simple anatomic problems to complex biopsychosocial issues. In addition, a woman can have more than one etiology of her pain.

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This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find Women's Health articles more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Female sexual pain (FSP)
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Female sexual pain (FSP)

FSP is vulvovaginal or pelvic pain that is provoked by or exacerbated during sexual contact. Sexual pain can be mild to severe, generalized or localized, lifelong or acquired, and idiopathic or secondary. The pain can be present for any amount of time.

FSP encompasses identifiable conditions that cause genital pain (eg, endometriosis, genitourinary syndrome of menopause, dermatoses) as well as generalized pain disorders such as pains with sexual activity, dyspareunia (pain with penetrative intercourse), vulvodynia (persistent vulvar pain of without an identifiable etiology), and vaginismus (difficulty in allowing vaginal penetration despite willingness to do so).

MCQ exam: clinical scenario

A 36 year old woman comes to the physician for evaluation of a 4 year history of infertility, severe dysmenorrhea and increasing pain with sexual intercourse. On pelvic examination an adnexal mass is felt and nodules are palpated along the uterosacral ligaments.

Which of the following is the most likely diagnosis?

a) dermoid cyst
b) ectopic pregnancy
c) endometriosis
d) follicular cyst
e) corpus luteum cyst

MCQ exam: answer

The correct answer is C.
This is a typical presentation of endometriosis.

MCQ exam: explanation

Endometriosis commonly occurs in the ovary; when cyclic bleeding occurs, an endometriotic cyst or endometrioma is formed. Accumulation of blood within this cavity results in the classic chocolate cyst. The pain that is typically produced by endometriosis is similarly produced with endometriomas of the ovary.

Physical examination reveals an adnexal mass and the typical findings of endometriosis, which include uterosacral nodularity and cul-de-sac of Douglas tenderness.

Reference(s)
1). UpToDate: Approach to the woman with sexual pain. Available online: https://www.uptodate.com/contents/approach-to-the-woman-with-sexual-pain