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Aetiology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Causes include:

Superficial:

  • infection - especially, trichomonas, vaginal candidiasis
  • vaginal atrophy - postmenopausal shrinkage; infrequent intercourse
  • inadequate or over-enthusiastic perineal repair following childbirth
  • other organic causes - such as vaginal / rectal tumour
  • psychological - vaginismus, fear, ignorance, previous painful intercourse
  • poor sexual stimulation

Deep:

  • pelvic inflammatory disease
  • endometriosis - especially, with deposits in the pouch of Douglas, uterosacral ligaments, posterior vaginal fornix
  • adenomyosis - less common than endometriosis
  • cervicitis
  • prolapsed ovaries in the pouch of Douglas
  • retroverted and retroflexed uterus - unlikely to cause significant dyspareunia unless associated pathology e.g. endometriosis
  • changed partner - changed shape / size of penis

Orgasmic:

  • psychological - pelvic congestion syndrome

Post coital:

  • allergy - for example, to sperm
  • pelvic inflammatory disease
  • psychosexual - only diagnosed once organic causes excluded

Considering Superficial or deep dysparuenia - Common causes of dyspareunia include (1):

diagnosis

superficial or deep

age group

vaginal and supporting structures

dermatological diseases e.g. – lichen planus, lichen sclerosus, psoriasis

superficial

all ages

inadequate lubrication

both

most common in reproductive years

perivaginal infections e,g, - urethritis, vaginitis

both

all ages

postpartum dyspareunia

both

reproductive years

vaginal atrophy

both

postmenopausal

vaginismus

superficial

more common in younger women

vulvodynia

superficial

all ages

other pelvic structures

adnexal pathology

deep

all ages

endometriosis

deep

reproductive years

infections e.g. – endometritis, PID

deep

all ages

interstitial cystitis

commonly deep

all ages

pelvic adhesions

deep

all ages

retroverted uterus

deep

all ages

uterine myomas

deep

reproductive years

Reference:

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