Pain during Sexual Intercourse (Dyspareunia): Examination

A comprehensive clinical examination (to rule out, for example, cervical cancer (cancer of the uterine cervix), fibroids, endometriosis, cysts, vaginal infections) is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdominal wall and inguinal region (groin area).
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sexual organs).
      • Vagina (vagina) [possibly vaginal skin atrophy due to estrogen deficiency (menopause); vaginal mycosis/fungal disease of the vagina]
      • Cervix uteri (cervix) or portio (cervix; transition from cervix uteri to vagina (vagina)) [Exclusion of a cervical carcinoma / cervical cancer], if necessary, taking a Pap smear (for early detection of cervical cancer).
    • Palpation (bimanual; palpation with both hands) of the internal genital organs:
      • Cervix uteri (cervix).
      • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
      • Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [Normal: free; in the case of endometriosis, cysts/chocolic cyst may need to be detected here].
      • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
      • Pelvic walls [Normal: free]
      • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear; in the case of endometriosis, endometriosis lesions, which appear as nodules, are often detectable here]
      • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [Normal: inconspicuous mucosa].
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.