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Aetiology

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Gynaecology

Dyspareunia in females

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infection - especially, trichomonas, vaginal candidiasis

vaginal atrophy - postmenopausal shrinkage; infrequent intercourse

inadequate or over-enthusiastic perineal repair following childbirth

other organic causes - such as vaginal / rectal tumour

psychological - vaginismus, fear, ignorance, previous painful intercourse

endometriosis - especially, with deposits in the pouch of Douglas, uterosacral ligaments, posterior vaginal fornix

adenomyosis - less common than endometriosis

prolapsed ovaries in the pouch of Douglas

retroverted and retroflexed uterus - unlikely to cause significant dyspareunia unless associated pathology e.g. endometriosis

changed partner - changed shape / size of penis

psychological - pelvic congestion syndrome

psychosexual - only diagnosed once organic causes excluded

Considering Superficial or deep dysparuenia - Common causes of dyspareunia include (1):

Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014;90(7):465-70.

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diagnosis	superficial or deep	age group
*vaginal and supporting structures*
dermatological diseases e.g. – lichen planus, lichen sclerosus, psoriasis	superficial	all ages
inadequate lubrication	both	most common in reproductive years
perivaginal infections e,g, - urethritis, vaginitis	both	all ages
postpartum dyspareunia	both	reproductive years
vaginal atrophy	both	postmenopausal
vaginismus	superficial	more common in younger women
vulvodynia	superficial	all ages
*other pelvic structures*
adnexal pathology	deep	all ages
endometriosis	deep	reproductive years
infections e.g. – endometritis, PID	deep	all ages
interstitial cystitis	commonly deep	all ages
pelvic adhesions	deep	all ages
retroverted uterus	deep	all ages
uterine myomas	deep	reproductive years

Aetiology

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