Beyond sexual dysfunction: dyspareunia as a diagnostic indicator of urinary tract infection

Abstract

Introduction Dyspareunia may be the sole presenting symptom in women with undiagnosed urinary tract infections (UTIs). While in postmenopausal women it is commonly linked to Genitourinary Syndrome of Menopause (GSM), UTIs represent the second most frequent cause of dyspareunia in this population. This underdiagnosis likely stems from limited provider-patient communication about sexual health and a tendency to attribute the pain solely to hormonal or psychosexual causes. This reflects significant gaps in medical education regarding sexual symptoms. Objective The objective is to highlight the importance of dyspareunia as a common but often overlooked symptom of UTIs, especially in premenopausal women, where it may indicate an underlying infection rather than Female Sexual Dysfunction (FSD). The study also aims to identify age-specific diagnostic patterns and emphasize the need for routine UTI screening in the differential diagnosis of dyspareunia. Methods A 14-year retrospective review was conducted to examine the relationship between dyspareunia and UTIs in women. The analysis focused on the prevalence of dyspareunia at the time of UTI diagnosis, its resolution following antibiotic treatment, and how often dyspareunia led to the diagnosis of a previously unrecognized infection. Results Dyspareunia was reported in approximately 83% of women with UTIs. Of these, 94% experienced complete resolution of symptoms after antibiotic therapy, suggesting a strong causal relationship between infection and pain during intercourse. Among reproductive-aged women, 80% of those who initially presented with dyspareunia were ultimately diagnosed with a previously unrecognized UTI, indicating that it may be the sole symptom. In contrast, in peri- and postmenopausal women, dyspareunia was more commonly associated with GSM, though coexisting infection was also identified in some cases. These findings reveal age-specific diagnostic patterns. Conclusions Sexologists, sexual health providers, gynecologists, urologists, and internal medicine specialists must recognize dyspareunia as an important but underestimated clinical symptom of UTIs. Routine inclusion of UTI screening in the differential diagnosis of dyspareunia is crucial, particularly in younger women, to ensure accurate diagnosis and appropriate treatment. Disclosure No