Differential Diagnosis
- Single most likely diagnosis
- Vaginal Atrophy (Hypoestrogenism): The patient's symptoms of pain, dryness, and burning during vaginal and oral sex, followed by dysuria, are consistent with vaginal atrophy. The 4-month period of abstinence may have contributed to decreased estrogenization of the vaginal mucosa, leading to these symptoms.
- Other Likely diagnoses
- Yeast Infection (Candidiasis): The patient's symptoms of burning and pain during sex, as well as dysuria, could be indicative of a yeast infection. The recent resumption of sexual activity may have disrupted the vaginal flora, leading to an overgrowth of Candida.
- Bacterial Vaginosis: This condition can cause vaginal dryness, burning, and dysuria, especially after sexual activity. The patient's symptoms and recent sexual activity make this a plausible diagnosis.
- Urinary Tract Infection (UTI): The patient's symptom of burning while urinating is a classic sign of a UTI. The recent sexual activity may have introduced bacteria into the urinary tract, leading to an infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sexually Transmitted Infections (STIs): Although the patient reports being sexually active with only one partner, it is essential to consider the possibility of STIs, such as gonorrhea, chlamydia, or herpes, which can cause similar symptoms. Missing these diagnoses could lead to severe consequences, including infertility and long-term health problems.
- Pelvic Inflammatory Disease (PID): This condition can cause severe pelvic pain, burning, and dysuria. If left untreated, PID can lead to infertility, chronic pain, and increased risk of ectopic pregnancy.
- Rare diagnoses
- Lichen Sclerosus: A rare condition that can cause vaginal dryness, burning, and pain. Although unlikely, it should be considered if other diagnoses are ruled out.
- Vulvar Vestibulitis: A condition characterized by chronic pain and burning in the vulvar area, which could be a possible explanation for the patient's symptoms. However, this diagnosis is less likely given the acute onset of symptoms after sexual activity.