Aetiology
Causes include:
Superficial:
- 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
- poor sexual stimulation
Deep:
- pelvic inflammatory disease
- endometriosis - especially, with deposits in the pouch of Douglas, uterosacral ligaments, posterior vaginal fornix
- adenomyosis - less common than endometriosis
- cervicitis
- 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
Orgasmic:
- psychological - pelvic congestion syndrome
Post coital:
- allergy - for example, to sperm
- pelvic inflammatory disease
- psychosexual - only diagnosed once organic causes excluded
Considering Superficial or deep dysparuenia - Common causes of dyspareunia include (1):
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 |
Reference:
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