Differential Diagnosis for Pelvic Pain during Intercourse
- Single most likely diagnosis
- C) Genito-pelvic pain/penetration disorder: This diagnosis is the most likely because the patient's primary complaint is intense pelvic pain during attempted intercourse, which is a key characteristic of genito-pelvic pain/penetration disorder. The patient's avoidance of intimacy due to anxiety about the pain also aligns with this diagnosis.
- Other Likely diagnoses
- A) Female sexual interest/arousal disorder: While the patient's primary issue is pain, her avoidance of intimacy could also suggest a decrease in sexual interest or arousal, making this a possible secondary diagnosis.
- B) Generalized anxiety disorder: The patient's significant anxiety about intercourse, to the point of avoiding intimacy, could be part of a broader pattern of generalized anxiety, although the primary focus is on the pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Endometriosis or other underlying gynecological conditions: Although not directly listed as an option, it's crucial to consider underlying medical conditions that could cause pelvic pain during intercourse. Conditions like endometriosis, pelvic inflammatory disease, or ovarian cysts need to be ruled out due to their potential for serious health implications if left untreated.
- D) Somatic symptom disorder: While less likely, somatic symptom disorder could be considered if the pain is deemed to be significantly disproportionate to any identifiable medical condition, and the patient's thoughts, feelings, or behaviors related to the pain are maladaptive.
- Rare diagnoses
- E) Specific phobia: This would be an unlikely diagnosis unless the patient's anxiety about intercourse is specifically due to a fear that is excessive and persistent, which is not clearly indicated in the scenario provided.
- Vaginismus or other rare conditions: Conditions like vaginismus, where there is involuntary tightening of the vaginal muscles, could be considered but are less common and would typically be diagnosed after other conditions have been ruled out.