What is the diagnosis for a 35-year-old female with a history of a third-degree perineal tear (3rd degree tear) with her first child, episiotomy with her second, and cesarean section (C-section) with her third, presenting with dysuria (painful urination), urinary retention, dyspareunia (painful sex), and pelvic floor pain?

Pelvic Floor Dysfunction: Given the patient's history of a 3rd degree tear, episiotomy, and cesarean section, it is likely that she has developed pelvic floor dysfunction. This condition can cause painful urination, urinary retention, painful sex, and general pelvic floor pain due to weakened or damaged pelvic floor muscles.

Vulvar Vestibulitis: This condition is characterized by chronic pain in the vulvar vestibule, which could be exacerbated by the patient's history of vaginal deliveries and episiotomy. It could contribute to painful sex and pelvic floor pain.
Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could explain the patient's painful urination and urinary retention.
Endometriosis: Although not directly related to the patient's obstetric history, endometriosis could cause pelvic floor pain, painful sex, and urinary symptoms, especially if the endometrial implants are located near the bladder or ureters.

Urinary Tract Infection or Pyelonephritis: Infections in the urinary tract can cause severe pain, urinary retention, and systemic symptoms. It is crucial to rule out these conditions due to their potential for serious complications if left untreated.
Pelvic Organ Prolapse: Although less likely given the patient's age and parity, a prolapse could cause pelvic floor pain, urinary retention, and painful sex. It is essential to consider this diagnosis to prevent missing a condition that may require surgical intervention.
Malignancy (e.g., Cervical, Uterine, or Ovarian Cancer): Although rare, it is critical to consider malignancy as a potential cause of pelvic floor pain, especially if accompanied by other symptoms like abnormal vaginal bleeding or significant weight loss.

Pudendal Neuralgia: A condition characterized by chronic pain in the distribution of the pudendal nerve, which could cause painful sex, urination, and pelvic floor pain. It is less common but should be considered if other diagnoses are ruled out.
Tarlov Cysts: Rare, fluid-filled sacs that can form on the nerve roots in the spine, potentially causing pelvic floor pain, among other symptoms. They are relatively rare and usually diagnosed incidentally on imaging studies.