Differential Diagnosis for Insertion Pain during Intercourse post Menopause with History of Endometriosis

• Single most likely diagnosis
  • Vaginal atrophy: This condition is very common in postmenopausal women due to the decrease in estrogen levels, leading to thinning and drying of the vaginal walls, which can cause pain during intercourse.
• Other Likely diagnoses
  • Recurrent endometriosis: Given the patient's history of endometriosis, it's possible that the condition has recurred, causing pain during intercourse.
  • Vulvodynia: This is a chronic pain condition that affects the vulva and can cause pain during intercourse.
  • Pelvic floor dysfunction: Weakness or tightness in the pelvic floor muscles can lead to pain during intercourse.
• Do Not Miss diagnoses
  • Ovarian cancer: Although less likely, ovarian cancer can cause pelvic pain and should not be missed, especially in postmenopausal women.
  • Endometrial cancer: Similarly, endometrial cancer can cause pain during intercourse and should be considered, particularly if there are other symptoms like abnormal vaginal bleeding.
• Rare diagnoses
  • Vestibulodynia: A rare condition characterized by chronic pain in the vestibular area of the vulva, which can cause pain during intercourse.
  • Lichen sclerosis: A rare skin condition that can cause thinning and scarring of the vulvar skin, leading to pain during intercourse.
  • Neurological disorders (e.g., pudendal neuralgia): Rare conditions that can cause chronic pain in the pelvic area, including during intercourse.