BIOPSYCHOSOCIAL PROFILE OF WOMEN WITH DYSPAREUNIA

Objective: To compare biopsychologic profiles of women with dyspareuni a with a matched no-pain control sample, and to determine whether dysp areunia subtypes based on physical findings have different psychosocia l profiles from matched controls. Methods: One hundred and five women with dyspareunia and 105 matched no-pain control women underwent stand ard gynecologic examination, endovaginal ultrasound, and colposcopy. T hey also completed a structured interview inquiring about pain other t han dyspareunia, sexual function, and history of abuse, the Brief Symp tom Inventory, the Sexual Opinion Survey, and the Locke-Wallace Marita l Adjustment Scale. Results: In comparison with women who do not exper ience pain with intercourse, the dyspareunia sample was found to have more physical pathology on examination, and they reported more psychol ogic symptomatology, more negative attitudes toward sexuality, higher levels of impairment in sexual function, and lower levels of marital a djustment. They did not report more current or past physical or sexual abuse. However, when the undifferentiated dyspareunia sample was divi ded into subtypes based on physical findings from the gynecologic exam inations, the pattern of significant differences from controls varied according to dyspareunia subtype. Elevated psychologic symptomatology and relationship maladjustment were confined to the subtype with no di scernible physical findings who reported levels of sexual function not significantly different from matched controls. The vulvar vestibuliti s subtype suffered the highest levels of sexual impairment, although t his subtype was not characterized by higher levels of psychologic symp toms than controls. Conclusion: As an undifferentiated group, women wi th dyspareunia have more physical pathology, psychologic distress, sex ual dysfunction, and relationship problems. However, this pattern of d ifferences appears to vary depending on the presence and type of physi cal findings evident on examination. Dyspareunia is a heterogeneous di sorder requiring comprehensive gynecologic and psychosocial assessment to determine differentiated treatment strategies. (C) 1997 by The Ame rican College of Obstetricians and Gynecologists.