Differential Diagnosis
- Single most likely diagnosis
- Vaginal atrophy (atrophic vaginitis): This condition is likely due to the patient's 4-month period of abstinence from intercourse, leading to decreased estrogen levels and vaginal dryness. The pain, dryness, and burning during vaginal and oral sex, as well as the burning while urinating, are consistent with this diagnosis.
- Other Likely diagnoses
- Yeast infection (candidiasis): The patient's symptoms of burning during sex and urination could be indicative of a yeast infection, which is a common condition in sexually active women.
- Bacterial vaginosis: This condition can cause vaginal dryness, burning, and discomfort during sex, and is also a possible explanation for the patient's symptoms.
- Urinary tract infection (UTI): The patient's complaint of burning while urinating suggests a possible UTI, which can be caused by bacterial infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sexually transmitted infections (STIs) such as gonorrhea, chlamydia, or herpes: Although the patient reports being sexually active with only one partner, it is still possible that she may have contracted an STI, which could have serious consequences if left untreated.
- Pelvic inflammatory disease (PID): This condition can cause severe pelvic pain, burning during urination, and other symptoms, and can lead to serious complications such as infertility if not promptly treated.
- Rare diagnoses
- Lichen sclerosis: This is a rare condition that can cause vaginal dryness, burning, and discomfort during sex, but is less likely than other diagnoses.
- Vulvar vestibulitis: This condition can cause burning pain during vaginal entry, but is relatively rare and may not fully explain the patient's symptoms.