Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Multidisciplinary Vulvodynia Program, Vancouver, BC, Canada.
Sex Med Rev. 2017 Oct;5(4):495-507. doi: 10.1016/j.sxmr.2017.06.005. Epub 2017 Aug 1.
Endometriosis is a common chronic disease affecting 1 in 10 women of reproductive age, with half of women with endometriosis experiencing deep dyspareunia. A review of research studies on endometriosis indicates a need for a validated question or questionnaire for deep dyspareunia. Moreover, placebo-controlled randomized trials have yet to demonstrate a clear benefit for traditional treatments of endometriosis for the outcome of deep dyspareunia. The reason some patients might not respond to traditional treatments is the multifactorial nature of deep dyspareunia in endometriosis, which can include comorbid conditions (eg, interstitial cystitis and bladder pain syndrome) and central sensitization underlying genito-pelvic pain penetration disorder. In general, there is a lack of a framework that integrates these multifactorial causes to provide a standardized approach to deep dyspareunia in endometriosis.
To propose a clinical framework for deep dyspareunia based on a synthesis of pain mechanisms with genito-pelvic pain penetration disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Narrative review after literature search with the terms (endometriosis AND dyspareunia) OR (dyspareunia AND deep) and after analysis of placebo-controlled randomized trials.
Deep dyspareunia presence or absence or deep dyspareunia severity on a numeric rating scale or visual analog scale.
Four types of deep dyspareunia are proposed in women with endometriosis: type I that is directly due to endometriosis; type II that is related to a comorbid condition; type III in which genito-pelvic pain penetration disorder is primary; and type IV that is secondary to a combination of types I to III.
Four types of deep dyspareunia in endometriosis are proposed, which can be used as a framework in research studies and in clinical practice. Research trials could phenotype or stratify patients by each type. The framework also could give rise to more personalized care for patients by targeting appropriate treatments to each deep dyspareunia type. Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev 2017;5:495-507.
子宫内膜异位症是一种常见的慢性疾病，影响着 10 名育龄妇女中的 1 名，其中一半的子宫内膜异位症患者经历深部性交痛。对子宫内膜异位症研究的综述表明，需要有一种经过验证的问题或问卷来评估深部性交痛。此外，安慰剂对照随机试验尚未证明传统的子宫内膜异位症治疗对深部性交痛的结局有明显益处。一些患者对传统治疗没有反应的原因是子宫内膜异位症深部性交痛的多因素性质，其中可能包括合并症（例如间质性膀胱炎和膀胱疼痛综合征）和潜在的生殖器疼痛穿透障碍的中枢敏化。一般来说，缺乏一种整合这些多因素原因的框架，为子宫内膜异位症深部性交痛提供标准化的治疗方法。
根据《精神障碍诊断与统计手册》第五版，提出一种基于疼痛机制与生殖器疼痛穿透障碍综合的深部性交痛临床框架。
通过搜索文献，使用术语（子宫内膜异位症和性交痛）或（性交痛和深部）进行文献检索，然后对安慰剂对照随机试验进行分析。
存在或不存在深部性交痛，或用数字评分量表或视觉模拟量表评估深部性交痛的严重程度。
在患有子宫内膜异位症的女性中，提出了 4 种类型的深部性交痛：I 型是由子宫内膜异位症直接引起的；II 型与合并症有关；III 型是生殖器疼痛穿透障碍主要引起的；IV 型是由 I 至 III 型的组合引起的。
提出了 4 种类型的深部性交痛，可作为研究和临床实践的框架。研究试验可以通过每种类型对患者进行表型或分层。该框架还可以通过针对每种深部性交痛类型提供适当的治疗方法，为患者提供更个性化的护理。
