Differential Diagnosis for 25-year-old Female Patient
- Single most likely diagnosis
- Vaginal atrophy or vaginal dryness due to prolonged abstinence: This is the most likely cause of the burning pain and dryness during sexual intercourse after a period of abstinence. The symptoms resolved after repeated sexual activity, which is consistent with this diagnosis.
- Other Likely diagnoses
- Hormonal changes or irregular ovulation: The patient's menstrual period was due, but it did not start, which could be related to hormonal changes or irregular ovulation, possibly triggered by the recent sexual activity or other factors such as stress or weight changes.
- Cervical or vaginal irritation: The spotting after sexual intercourse could be due to cervical or vaginal irritation, which is a common cause of post-coital bleeding.
- Yeast infection or other vaginal infections: Although less likely, a yeast infection or other vaginal infections could cause burning pain and dryness during sexual intercourse, especially if the patient has been experiencing other symptoms such as itching or abnormal discharge.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the patient has not missed a period for a long time, it is essential to consider the possibility of an ectopic pregnancy, especially if the patient has a history of pelvic inflammatory disease, tubal surgery, or infertility.
- Cervical cancer: Post-coital bleeding can be a symptom of cervical cancer, and it is crucial to rule out this possibility, especially if the patient has a history of abnormal Pap smears or has not had a recent Pap smear.
- Pelvic inflammatory disease (PID): PID can cause pelvic pain, irregular bleeding, and infertility, and it is essential to consider this diagnosis, especially if the patient has a history of sexually transmitted infections or multiple sexual partners.
- Rare diagnoses
- Asherman's syndrome: This is a rare condition characterized by the formation of adhesions in the uterus, which can cause menstrual irregularities, infertility, and recurrent miscarriages. Although unlikely, it could be considered if the patient has a history of uterine surgery or instrumentation.
- Vaginal adenosis: This is a rare condition characterized by the presence of glandular tissue in the vagina, which can cause vaginal bleeding and discharge. Although unlikely, it could be considered if the patient has a history of vaginal surgery or radiation therapy.