Differential Diagnosis for Painful Intercourse
Single Most Likely Diagnosis
- Vaginismus: This condition, characterized by involuntary muscle spasms in the vaginal wall, is a common cause of painful intercourse (dyspareunia) in women. It can be due to psychological factors, past trauma, or physical conditions.
Other Likely Diagnoses
- Vulvodynia: A chronic pain condition that affects the vulva, causing burning, stinging, or aching sensations, which can make intercourse painful.
- Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, leading to pain during intercourse, especially if the endometrial implants are located behind the vagina or on the uterosacral ligaments.
- Vaginal Dryness: Insufficient lubrication due to hormonal changes, menopause, or certain medications can cause pain during intercourse.
- Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause pain during intercourse, along with other symptoms like abnormal vaginal discharge and pelvic pain.
Do Not Miss Diagnoses
- Ovarian Cysts: Large or ruptured ovarian cysts can cause severe pain during intercourse, and while not the most common cause, missing a ruptured cyst could be life-threatening.
- Ectopic Pregnancy: Although rare, an ectopic pregnancy can cause pain during intercourse, and missing this diagnosis can be fatal.
- Cancer (Cervical, Uterine, or Ovarian): While not common causes of dyspareunia, cancers in the reproductive organs can cause pain during intercourse, and early detection is crucial for treatment and survival.
Rare Diagnoses
- Lichen Sclerosus: A rare skin condition that can cause thinning and patchy skin in the genital area, leading to pain during intercourse.
- Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: A rare congenital disorder characterized by the absence or underdevelopment of the vagina and uterus, which can cause pain during attempted intercourse.
- Pudendal Neuralgia: A rare condition characterized by damage to the pudendal nerve, which can cause chronic pain in the genital area, including during intercourse.