Differential Diagnosis for Vaginal Pain

The patient presents with vaginal pain that starts prior to menses and worsens during menses, with episodes of sharp pain that are severe enough to interrupt daily activities. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Endometriosis: This condition is characterized by the presence of endometrial tissue outside the uterus, leading to cyclic pain that worsens with menstruation. The sharp, debilitating pain described by the patient is consistent with endometriosis, especially given its timing in relation to her menstrual cycle.

• Other Likely Diagnoses

  • Vulvodynia: A condition that causes chronic pain in the vulva, which can be exacerbated by menstruation and may cause sharp, stabbing pains.
  • Pelvic Adhesions: Scarring in the pelvic region, possibly from the vaginal delivery, could cause pain, especially if the adhesions involve or put pressure on surrounding organs or nerves.
  • Ovarian Cysts: These can cause sharp, intermittent pain, especially if they rupture or twist, and their symptoms can sometimes correlate with the menstrual cycle.

• Do Not Miss Diagnoses

  • Ectopic Pregnancy: Although less likely given the patient's presentation and recent postpartum evaluation, an ectopic pregnancy can cause severe, sharp pain and is a medical emergency.
  • Ovarian Torsion: A condition where the ovary twists around its ligaments, cutting off blood supply, which can cause sudden, severe pain and requires immediate medical attention.
  • Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause severe pain, especially if it involves the ovaries or fallopian tubes.

• Rare Diagnoses

  • Pudendal Neuralgia: A condition characterized by damage to the pudendal nerve, which can cause chronic pain in the vulva, vagina, or perineum.
  • Vestibulodynia: A subtype of vulvodynia that affects the vestibule of the vulva, causing pain upon touch or pressure.
  • Leiomyosarcoma (Uterine Sarcoma): A rare type of cancer that can cause pelvic pain, although it is much less common than other causes of pelvic pain and would typically be associated with other symptoms such as abnormal vaginal bleeding.