Uterine Suspension in the Management of Collision Dyspareunia

Background

Dyspareunia is a multi-faceted problem that can involve a number of factors and disease states. Women rarely report it on their own but may discuss the issue upon direct inquiry. Evaluation of a patient responding affirmatively should involve a complete and careful sexual history and a comprehensive physical exam. It is important to identify the severity, character and location of pain during intercourse. This information can be used to determine whether the patient is experiencing superficial or deep dyspareunia or both.

In cases of deep dyspareunia, particular attention should be paid to uterine position during the pelvic exam. If the pain experienced during intercourse can be reproduced with a digital exam, the patient is a good candidate for uterine suspension. Some investigators have advocated a pessary trial prior to uterine suspension. However, others have noted that the trial is unnecessary and that pessary use can cause sexual dysfunction and further gynecological concerns. ¹ Uterine suspension represents a long-term solution for women with dyspareunia secondary to a retroverted uterus.

Documentation

In a series of 75 women with a symptomatic retroverted uterus who underwent laparoscopic uterine suspension, Carter found that 84% (n=63) reported complete relief from dyspareunia with up to two-years follow-up. ² Another 7% (n=5) reported mild pain and 4% (n=3) moderate pain. For all 75 patients, pain with intercourse decreased from 8.1 to 1.5 on a 10-point scale (0= no pain and 10= the worst pain the patient has ever experienced). Each patient was evaluated for degree of retroversion and was assessed by ultrasound to identify any uterine or ovarian abnormalities. Dyspareunia was reproduced by palpation of the retroverted uterus.

Ostrzenski found that all patients (n=32) who underwent laparoscopic uterine suspension for symptomatic uterine retroversion reported complete relief from dyspareunia after at least 24-months follow-up. ³ Surgery was conducted in the context of a prospective randomized study.

Batioglu performed laparoscopic uterine suspension on 30 women with chronic pelvic pain unexplained by causes other than uterine retroversion. ⁴ Dyspareunia was resolved in 19 of the 20 women who completed two-year follow-up. The one woman still experiencing dyspareunia had a retroverted uterus and refused a second suspension procedure.

Gargiulo concluded that uterine suspension effectively relieves dyspareunia after conducting a prospective study of 50 women with symptomatic uterine retroversion and no other clinical findings to explain their symptoms. ⁵ At one year follow-up, 33 of the 40 women remaining in the study had an anteverted uterus, complete remission of pain and a markedly improved sex life.

Other researchers have reached similar conclusions on the efficacy of uterine suspension based for dyspareunia related to a retroverted uterus based on their findings:

• Koh – 100% (n=22) of the women reported that "their sexual life had tremendously improved." at up to two years follow-up. ⁶
• Serour – 89% (n=75) of women improved with follow-up of 6 to 30 months. ⁷
• Patterson – 76% (n = 53) experienced complete relief of dyspareunia and 14% (n=10) had partial relief with a mean follow-up of 40.5 months. ⁸

Conclusion

Uterine suspension provides effective long-term relief of deep dyspareunia due to a retroverted uterus.

References

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