Differential Diagnosis for Decreased Libido and Painful Intercourse
- Single Most Likely Diagnosis
- Hypoestrogenism (postmenopausal or perimenopausal state): The patient's symptoms of decreased libido, pain with intercourse, and physical examination findings of scant pubic hair and pale vulvovaginal mucosa are consistent with a hypoestrogenic state. The patient's age and the presence of small, nontender ovaries also support this diagnosis.
- Other Likely Diagnoses
- Vaginal atrophy: This condition is common in postmenopausal women and can cause pain with intercourse, decreased libido, and vaginal dryness.
- Endometriosis recurrence: Although the patient had a laparoscopic hysterectomy for endometriosis, it is possible that the condition has recurred, causing pain with intercourse.
- Vulvodynia: This is a chronic pain condition that can cause pain with intercourse and decreased libido.
- Psychogenic causes: The patient's marital issues and avoidance of sexual intimacy may have a psychological component, such as anxiety or depression, contributing to her decreased libido and pain with intercourse.
- Do Not Miss Diagnoses
- Ovarian cancer: Although the patient's ovaries are small and nontender, ovarian cancer can present with nonspecific symptoms, including pain with intercourse and decreased libido.
- Pelvic inflammatory disease (PID): PID can cause pain with intercourse and decreased libido, and it is essential to rule out this diagnosis, especially if the patient has a history of sexually transmitted infections.
- Lichen sclerosis: This is a chronic skin condition that can cause pain with intercourse, decreased libido, and vaginal dryness.
- Rare Diagnoses
- Sjögren's syndrome: This autoimmune disorder can cause vaginal dryness and pain with intercourse.
- Neurological disorders (e.g., multiple sclerosis, peripheral neuropathy): These conditions can cause decreased libido and pain with intercourse due to nerve damage.
- Systemic diseases (e.g., diabetes, thyroid disorders): Certain systemic diseases can cause decreased libido and pain with intercourse, although these are less likely given the patient's overall health and physical examination findings.