Dyspareunia causes

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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] Luke Rusowicz-Orazem, B.S. Roghayeh Marandi

Overview

Common causes of dyspareunia in premenopausal women include the most frequent biological etiologies of dyspareunia which are vulvar vestibulitis/provoked vestibulodynia, with recurrent candida infections and/or a hyperactive pelvic floor in the background, and painful outcomes of delivery (either because of episiotomy/rraphy, or traumatic deliveries). Endometriosis, chronic pelvic pain, and pelvic inflammatory disease are leading contributors of deep dyspareunia in premenopausal women. Common causes of dyspareunia in postmenopausal women include vaginal dryness and vulvovaginal dystrophy, which are the leading etiological factors of dyspareunia, and may concur to deep dyspareunia, with iatrogenic factors such as surgical shortening of the vagina and/or radiotherapy contributing to deep sexual pain. Possible medical causes of dyspareunia should be ruled out or treated before considering a diagnosis of Genito-Pelvic Pain/Penetration Disorder(GPPPD). If a medical cause is successfully treated and pain has not been resolved yet, a diagnosis of vulvodynia or genito-pelvic/penetration disorder is appropriate to be considered.

Causes

Common causes

In premenopausal women:

• The most frequent biological etiologies of dyspareunia are vulvar vestibulitis/provoked vestibulodynia, with recurrent candida infections and/or an hyperactive pelvic floor in the background, and painful outcomes of delivery (either because of episiotomy/rraphy, or traumatic deliveries). Endometriosis, chronic pelvic pain, and pelvic inflammatory disease are leading contributors of deep dyspareunia in premenopausal women.

In postmenopausal women:

• vaginal dryness and vulvovaginal dystrophy are leading etiological factors of dyspareunia, and may concur to deep dyspareunia, with iatrogenic factors such as surgical shortening of the vagina and/or radiotherapy contributing to deep sexual pain.

• possible medical causes of dyspareunia should be ruled out or treated before considering a diagnosis of Genito-Pelvic Pain/Penetration Disorder(GPPPD). If a medical cause is successfully treated and pain has not been resolved yet, a diagnosis of vulvodynia or genito-pelvic/penetration disorder is appropriate to be considered.

Causes of dyspareunia in Women

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, Vaginismus or Genito-Pelvic Pain/Penetration Disorder(GPPPD) , 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

Medical and psychological causes of dyspareunia in men:

Medical causes	sexually transmitted infections ( STIs) including herpes, thrush or male candidiasis,tight foreskin (Phimosis), prostatitis,growths, cysts, warts, and lumps in the penis,testicular cancer,little tears in the foreskin,problems with ejaculation when the testicles swell and become painful as a result of being sexually stimulated but not ejaculating, penile fracture,Peyronie's disease, Isolated painful ejaculation due to:Urethritis,Prostatitis,Epididymitis,Orchitis,Abdominal abscess, Penile prosthesis, Bladder cancer,Intra-abdominal tumors, Prostate cancer, Vesical calculi,Benign prostatic hyperplasia (BPH),Urethral stricture,Pelvic musculature spasm,Radical prostatectomy,Transurethral resection of the prostate (TURP),Vasectomy,Frenulum breve), dermatologic conditions of the penis such as:( lichen planus,lichen sclerosis, Zoon's (plasma cell) balanitis,balanoposthitis)
Psychological causes	history of sexual abuse or trauma,stress,fear,depression,guilt,anxiety around sex,emotional instability,strict religious upbringing
Other causes	allergic reaction and skin irritation to a particular brand of condom or spermicide, sharp pain during penetration can be caused by threads of an intrauterine contraceptive device (for birth control) that protrude from the woman’s cervix