Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

Introduction: Deep dyspareunia negatively affects women's sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive- age women; however, other factors are less clear in this population. Aim: To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive- age women at a referral center. Methods: This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/ or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasoundassisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site. Main Outcome Measure: Severity of deep dyspareunia on a numeric pain rating scale of 0 to 10. Results: Severity of deep dyspareunia (scale = 0-10) was independently associated with tenderness of the bladder (b = 0.88, P =.018), pelvic floor (levator ani) ( b = 0.66, P =.038), cervix and uterus (b = 0.88, P =.008), and cul- de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = -0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P <.001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P =.008) and pelvic floor (b = 1.07, P <.001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P =.001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b -3.54, P <.001). Conclusions: In reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the bladder, pelvic floor, and cervix and uterus. Copyright (C) 2017, The Authors. Published by Elsevier Inc.