Abstract
We critically review the causes and treatments of deep dyspareunia. Endometriosis, pelvic congestion syndrome, and interstitial cystitis have been associated with deep dyspareunia. Although medical therapies may improve deep dyspareunia in women with endometriosis, laparoscopic excision of deep endometriotic lesions has been demonstrated to improve not only deep dyspareunia but also the quality of sex life. Deep dyspareunia related to the presence of pelvic congestion syndrome should be treated by pelvic vein embolization. Intravesical therapy may be effective in treating deep dyspareunia in women with interstitial cystitis. It remains unclear whether uterine myomas and adenomyosis are causes of deep dyspareunia. Treatment of deep dyspareunia should be mainly directed to causative factors; however, clinicians should keep in mind that secondary sexual dysfunction can arise from organic pelvic pathology.
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