VP05.16: Management of women with dyspareunia in a tertiary gynecology clinic

Dyspareunia is a common problem, yet training in sexual difficulties amongst medical students and speciality trainees in O&G is poor. There is poor correlation between symptoms and findings at laparoscopy in women with sexual pain. This study was undertaken as part of a QIP to improve pathways for patients with dyspareunia in a tertiary centre outpatient gynecological department (GOPD). All patients seen in GOPD during October and November 2019 with dyspareunia. Clinical letters and electronic records were reviewed. Data collected included whether dyspareunia was the primary reason for referral; if sexual pain was voluntarily disclosed by patients or elicited by the clinician; performance of clinical examination; medical therapies; subsequent referral to other specialities; and if diagnostic laparoscopy was performed. A total of 685 patients were included. 103 (15%) patients with dyspareunia were identified. 83% were seen by trainees and 15% by a consultant gynecologist. Only 61% of patients had a physical examination. 30% of those had abdominal tenderness, 13% had vulval/vaginal pain, and 14% had an abdominal mass. 15% of patients underwent diagnostic laparoscopy; 17% of patients were referred to specialist services, including psychosexual clinic, vulval clinic, counselling and pain clinic. 15 different medical therapies were identified, and 9 different further speciality referrals. 68% were discharged from clinic without follow-up, including 50% of those prescribed medical therapies. Dyspareunia affects 15% patients in GOPD. Diagnostic laparoscopy rates were low but had low diagnostic merit, with a 60% negative rate. 39% were not examined, which means physical causes had not been excluded. 14% had pelvic masses which is concerning Patients expect gynecologists to be confident in sexual problems but there was lack of consistency in assessment and management, poor utilisation of specialist services and insufficient follow-up. This inadequate approach demonstrates an urgent need for better education amongst clinicians.