Differential Diagnosis for Painful Sex

• Single Most Likely Diagnosis
  • Vaginismus: This condition is characterized by involuntary muscle spasms in the vaginal wall, making penetration painful or impossible. It's a common cause of painful sex, especially in women who have experienced trauma or anxiety related to sex.
• Other Likely Diagnoses
  • Vulvodynia: A chronic condition that causes vulvar pain, burning, or discomfort, which can make sex painful.
  • Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, leading to painful periods, intercourse, and other symptoms.
  • Vaginal dryness or atrophy: Decreased estrogen levels, often due to menopause or breastfeeding, can cause vaginal dryness, leading to painful sex.
  • Pelvic inflammatory disease (PID): An infection of the female reproductive organs that can cause pain during sex.
• Do Not Miss Diagnoses
  • Ovarian cysts or torsion: These conditions can cause severe pelvic pain, including during sex, and require prompt medical attention.
  • Ectopic pregnancy: A pregnancy that develops outside the uterus can cause abdominal and pelvic pain, including during sex.
  • Cancer (cervical, uterine, or ovarian): Although rare, cancer can cause painful sex, and early detection is crucial for effective treatment.
• Rare Diagnoses
  • Lichen sclerosis: A rare skin condition that can cause thinning and patchy skin on the vulva, leading to pain and discomfort during sex.
  • Vestibulodynia: A condition that causes pain in the vulvar vestibule, which can make sex painful.
  • Adhesions or scar tissue: Abnormal tissue growth or scarring in the pelvic area can cause pain during sex, often due to surgery, injury, or infection.