aetiology
Last edited 09/2018
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: