Department of ObGyn, Oregon Health and Science University, Portland, OR.
St. Luke's Clinic - Urogynecology, Boise, ID.
Menopause. 2022 Jun 1;29(6):646-653. doi: 10.1097/GME.0000000000001956.
A common symptom of genitourinary syndrome of menopause (GSM) is dyspareunia, attributed to vulvovaginal atrophy. Our objective was to systematically describe the pain characteristics and anatomic locations of tenderness in a cohort with moderate/severe dyspareunia likely due to GSM.
This cross-sectional study reports the baseline data of postmenopausal women with dyspareunia screened for an intervention trial of topical estrogen. Postmenopausal women not using hormone therapy who had moderate or severe dyspareunia were eligible if estrogen was not contraindicated. Biopsychosocial assessments were performed using the Vulvar Pain Assessment Questionnaire, and participants underwent a systematic vulvovaginal examination that included a visual assessment and cotton swab testing for tenderness rated using the Numerical Rating Scale (0-10). Vaginal pH and mucosal sensitivity were assessed; pelvic floor muscles and pelvic viscera were palpated for tenderness.
Fifty-five eligible women were examined between July 2017 and August 2019. Mean age was 59.5 ± 6.8 years, and duration of dyspareunia was 6.2 ± 4.3 years. The mean intercourse pain score was 7.3 ± 1.8, most often described as "burning" and "raw." Ninety-eight percent had physical findings of vulvovaginal atrophy. Median pain scores from swab touch at the vulvar vestibule (just outside the hymen) were 4 to 5/10, and topical lidocaine extinguished pain. Median vaginal mucosal pain was zero.
Participants described their pain as "burning" and "dry." Tenderness was most severe and most consistently located at the vulvar vestibule. Correlating the symptom of dyspareunia with genital examination findings may further our understanding of treatment outcomes for GSM.
绝经后生殖泌尿系统综合征（GSM）的常见症状是性交痛，归因于外阴阴道萎缩。我们的目的是系统描述一组中重度 GSM 相关性交痛患者的疼痛特征和压痛解剖位置。
本横断面研究报告了接受雌激素局部治疗干预试验筛选的性交痛绝经后妇女的基线数据。如果雌激素没有禁忌证，则不使用激素治疗且有中度或重度性交痛的绝经后妇女有资格参加。使用外阴疼痛评估问卷进行了生物心理社会评估，并且参与者接受了系统的外阴阴道检查，包括外阴视觉评估和棉签触诊压痛，压痛使用数字评分量表（0-10）进行评分。评估了阴道 pH 值和黏膜敏感性；触诊评估盆底肌肉和盆腔内脏有无压痛。
2017 年 7 月至 2019 年 8 月期间，55 名符合条件的妇女接受了检查。平均年龄为 59.5±6.8 岁，性交痛持续时间为 6.2±4.3 年。性交疼痛评分的平均值为 7.3±1.8，最常描述为“灼热”和“刺痛”。98%的人有外阴阴道萎缩的体格检查结果。外阴前庭（处女膜外）棉签触诊的中位数疼痛评分为 4-5/10，局部利多卡因可消除疼痛。阴道黏膜疼痛中位数为 0。
参与者将疼痛描述为“灼热”和“干燥”。压痛最严重且最常位于外阴前庭。将性交痛症状与生殖器检查结果相关联，可能会进一步了解 GSM 的治疗效果。
