Detailed definition
Dyspareunia refers to recurrent or persistent genital pain associated with sexual intercourse. It is classified by location (entry vs. deep), timing (during vs. after intercourse), and acuity. In menopausal women, the most common cause is GSM-related vaginal atrophy, which produces entry dyspareunia from a thin, dry, friable epithelium with reduced lubrication. Other causes include vulvodynia, lichen sclerosus, vaginismus, pelvic floor dysfunction, endometriosis, pelvic adhesions, infection, and post-surgical changes. Workup involves a careful history, examination of the vulva and vagina (looking for atrophy, lichenoid changes, fissures), and consideration of a pelvic floor evaluation. For postmenopausal dyspareunia from atrophy, vaginal estrogen restores epithelial thickness, glycogen, and lubrication; intravaginal DHEA (prasterone) and oral ospemifene are alternatives. Lubricants and moisturizers are useful adjuncts but do not reverse the underlying tissue change.
Why it matters in menopause
Many women stop having sex rather than discuss painful intercourse. The condition is treatable, the treatments are low-risk, and improvement is reliable. Bringing dyspareunia into the menopause visit specifically — rather than waiting for the patient to mention it — substantially increases treatment uptake.