Dyspareunia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]; Jesus Rosario Hernandez, M.D. [3]

Overview

Possible medical causes of dyspareunia should be ruled out or treated before considering a diagnosis of Genito-Pelvic Pain/Penetration Disorder(GPPPD). GPPPD is actually an umbrella term for two sexual pan disorders:dyspareunia and vaginismus. Medical causes of dyspareunia in women including: Endometriosis,Atrophic vaginitis,Vaginal dryness,Infections(Human papillomavirus, Herpes simplex virus, Pelvic inflammatory disease, Chronic salpingitis, uterine fibroids, pelvic adhesions, adnexal pathology, retoverted uterus,chronic cervicitis, pelvic congestion, genitourinary( urethral, cystitis, Interstitial cystitis, psychological problems such as anxiety, depression in women and inadequate sexual stimuli,lichen sclerosis,pelvic inflammatory disease, premature ejaculation in the male, isolated painful ejaculation, chronic pelvic syndrome, genitourinary problems such as urethritis, and psychological problems in men.

Differentiating GPPPD from Other medical causes of dyspareunia in females

Cardiovascular	Hemorrhoids,Anal fissure, Renal nutcracker syndrome , Thrombosed piles
Dermatologic	Allergic contact dermatitis, Healed perineal lacerations, Irritant contact dermatitis, Kraurosis vulvae, Lichen planus, Lichen sclerosus, Obstetric perineal injury
Ear Nose Throat	Sjögren's syndrome
Endocrine	Menopause, Perimenopause, Prolactin secreting pituitary tumour, Prolactinoma, Reduced estrogen, Reduced libido
Gastroenterologic	Inflammatory bowel disease , Irritable bowel syndrome
Genetic	Congenital absence of lower part of vagina, Müllerian anomalies
Iatrogenic	Episiotomy, Gynecologic surgery, Obstetric surgery, Vaginal surgery
Infectious Disease	Atrophic vaginitis, Atrophic vulvitis, Atrophic vulvovaginitis, Autoimmune interstitial cystitis , Bartholin gland cyst, Bartholinitis, Candida albicans, Candidiasis, Chlamydia, Cystitis, Herpes simplex virus, Herpes virus 2, Pelvic infection, Trichomonas vaginalis, Trichomonas, Trichomoniasis , Urethritis, Urinary tract infection, Vaginitis, Vulva infection, Vulvovaginitis
Musculoskeletal/Orthopedic	Parkinson’s disease, Vaginismus, Vulval dystrophy
Neurologic	Parkinson’s disease, Peripheral neuropathies
Obstetric/Gynecologic	Atrophic vaginitis, Atrophic vulvitis, Atrophic vulvovaginitis, Autoimmune endometriosis , Autoimmune interstitial cystitis , Bartholin gland cyst, Bartholinitis, Chronic pain syndromes, Congenital absence of lower part of vagina, Endometrial conditions, Endometriosis, Episiotomy, Estrogen deficiency, Estrogen-based contraceptives, Female genital mutilation, Genital system cancer , Genital tract tumor, Genital ulcers, Gonorrhea, Gynaecological conditions , Gynecologic surgery, Healed perineal lacerations, Hemorrhoids, Imperforate hymen, Inflamed hymeneal orifice, Lactation, Myofascial pelvic pain syndrome, Narrow vagina, Obstetric perineal injury, Obstetric surgery, Ovarian tumour, Pelvic adhesions, Pelvic disorders, Pelvic infection, Pelvic inflammatory disease, Pelvic malignancy, Pelvic organ prolapse, Pelvic tumor, Perimenopause, Poor vaginal lubrication, Post-childbirth, Prolapsed tender ovaries with retroverted uterus, Remnants of the hymen, Salpingo-oophoritis, Unruptured hymen, Vagina cancer, Vaginal abnormality, Vaginal dryness, Vaginal surgery, Virilising ovarian tumour , Vulva infection, Vulval dystrophy, Vulval neoplasia, Vulvar vestibulitis syndrome , Vulvitis, Vulvovaginitis, Vulvodynia, Provoked vestibulodynia,
Oncologic	Genital system cancer , Genital tract tumor, Ovarian tumour, Pelvic malignancy, Pelvic organ prolapse, Pelvic tumor, Prolactin secreting pituitary tumour, Prolactinoma, Uterine sarcoma , Uterine tumour, Vagina cancer, Virilising ovarian tumour , Vulval neoplasia, Yolk sack tumour
Psychiatric	Anxiety, Depression, Psychological disorders, Reduced libido, Relationship dysfunction
Renal/Electrolyte	Interstitial cystitis, Renal nutcracker syndrome
Rheumatology/Immunology/Allergy	Arthritis of the hips, Fibromyalgia, Kraurosis vulvae, Lichen planus, Menopause, Scleroderma, Sicca syndrome, Sjögren's syndrome
Sexual	Chlamydia, Estrogen-based contraceptives, Female genital mutilation, Genital ulcers, Gonorrhea, Herpes simplex virus, Herpes virus 2, Trichomonas vaginalis, Trichomonas, Trichomoniasis
Trauma	Allen-masters syndrome , Anal fissure, Cystitis, Trauma
Urologic	Interstitial cystitis, Urethral caruncle, Urethritis, Urinary tract infection, Uterine sarcoma , Uterine tumour
Miscellaneous	Relationship dysfunction