Dyspareunia (deep or superficial)/Vulvodynia/Vestibulodynia/Genitopelvic Pain Penetration Disorder

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Acute symptoms of dyspareunia (e.g., sudden severe pain, fever, abnormal discharge, or bleeding)

    Note: Non acute Pelvic pain associated with dyspareunia should preferentially be in a chronic pelvic pain clinic.

    • Refer to HealthPathways and or local guidelines
    • Advise using lubricant and adequate foreplay prior to intercourse
    • All GPPPN patients consider referral to women’s health physiotherapist
    • For superficial dyspareunia:
      • breast feeding women – consider topical oestrogen
      • consider vaginismus and referral to a sexual medicine service +/- Pelvic floor physiotherapist
      • consider psychosocial issues and referral for counselling

    Clinical resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • No category 1 criteria
Category 2
(appointment within 90 calendar days)
  • Severe pelvic pain associated with dyspareunia
  • Unexplained persistent unusual vaginal discharge, especially if offensive and blood stained
Category 3
(appointment within 365 calendar days)
  • Vulvodynia/vulvar vestibulitis syndrome

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of:
    • nature of the pain – location, intermittent or persistent
    • general body muscle tensing and general or focal pelvic floor muscle tension before and during attempts at penetration
    • medical, surgical and obstetric history
  • Pelvic USS results (TVS preferable)

3. Additional referral information Useful for processing the referral

  • BMI
  • STI screen result
    • endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • HVS M/C/S and viral PCR result
  • Previous CST result (if within last 5 years)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 29 January 2025

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