Exploring the Diagnostic and Therapeutic Pathways of Women with Dyspareunia: A Mixed-Methods Study.

Background/Objectives: This study explores the diagnostic and management pathways for dyspareunia in women seeking specialist care, focusing on gynecologists' feedback and women's perceptions of their experience. Methods: An online survey was conducted among 225 sexually active women to explore their perceptions of dyspareunia, its impact on relationships, and experiences with healthcare feedback, diagnosis, and treatment. The Numeric Rating Scale (NRS) for pain assessment and the Female Sexual Function Index (FSFI) were used. Gynecologists' feedback was classified as positive, neutral, or negative based on its influence on the therapeutic pathway. Results: Of 78 women reporting dyspareunia, 12 with pain level ≥5 on NRS were selected for in-depth analysis. The mean pain score was 7.0 ± 1.53, with symptoms lasting from several months to over two years and occurring during most sexual encounters. The mean FSFI score was 24.86 ± 4.54, with half of the participants scoring within the sexual dysfunction range. Qualitative findings revealed frequent dismissive responses from healthcare professionals and limited access to appropriate management. Common self-management strategies included changing sexual positions and using lubricants, while half of the participants had not undergone a formal diagnostic process. Most frequent diagnoses were hormonal disorders and recurrent genital tract infections, and women were advised to undergo pharmacological treatment. Half of the participants were unaware of the possibility of physiotherapeutic management. Conclusions: Women with dyspareunia often face an inadequate diagnostic and therapeutic process. The care received is often insufficient and not aligned with a biopsychosocial model.