Dyspareunia causes: Difference between revisions

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==Causes==
Numerous medical causes of dyspareunia exist, ranging from [[infection]]s ([[candidiasis]], [[chlamydia]], [[trichomoniasis]], [[urinary tract infection]]s), [[endometriosis]], [[tumor]]s, [[xerosis]] (dryness, especially after the [[menopause]]) and [[Lichen sclerosus et atrophicus|LSEA]]. Dyspareunia may result from female genital mutilation, when the introitus has become too small for normal penetration (often worsened by scarring).


===Physical Causes===
==Overview==
Because there are numerous physical conditions that can contribute to pain during sexual encounters, a careful [[physical examination]] and [[medical history]] are always indicated with such complaints. In women, common physical causes for coital discomfort include infections of the vagina, lower urinary tract, cervix, or fallopian tubes (e.g., [[mycotic]] organisms (esp. [[candidiasis]]), [[chlamydia]], [[trichomonas]], [[coliform bacteria]]); [[endometriosis]]; surgical scar tissue (following episiotomy); and ovarian cysts and tumors (Bancroft 1989). In addition to infections and chemical causes of dyspareunia such as monilial organisms and herpes, anatomic conditions, such as hymenal remnants, can contribute to coital discomfort (Sarrell and Sarrell 1989). [[Estrogen]] deficiency is a particularly common cause of sexual pain complaints among postmenopausal women, although vaginal dryness is often reported by lactating women as well (Bachmann et al 1984). Women undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma. Vaginal dryness is sometimes seen in [[Sjögren's syndrome]], an autoimmune disorder which characteristically attacks the exocrine glands that produce saliva and tears.  
Common causes of dyspareunia include localized [[infectious]] and [[congenital]] disorders of the [[vulva]], [[vagina]], and [[perianal]] regions. Additional causes include systemic conditions and diseases.


Dyspareunia is now believed to be one of the first symptoms of a disease called [[interstitial cystitis]] (IC). Patients may struggle with bladder pain and discomfort during or after sex. For men with IC, pain occurs at the moment of ejaculation and is focused at the tip of the penis. For women with IC, pain usually occurs the following day, the result of painful, spasming pelvic floor muscles. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency.
==Causes==
===Common Causes===
*[[Anal fissure]]
*[[Anxiety]]
*[[Atrophic vulvovaginitis]]
*[[Bartholin gland cyst]]
*[[Candida albicans]]
*[[Candidiasis]]
*[[Chlamydia]]
*[[Depression]]
*[[Endometriosis]]
*[[Episiotomy]]
*[[Functional disorders]]
*[[Genital ulcers]]
*[[Herpes simplex virus]]
*[[Herpes virus 2]]
*[[Imperforate hymen]]
*[[Kraurosis vulvae]]
*[[Lichen sclerosus]]
*[[Menopause]]
*[[Pelvic inflammatory disease]]
*[[Sicca syndrome]]
*[[Trichomonas vaginalis]]
*[[Vaginismus]]
*[[Vulvovaginitis]]


=== Physical Causes in Men ===
===Causes by Organ System===
In men, as in women, there are a number of physical factors that may cause sexual discomfort. Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation. Men suffering from [[interstitial cystitis]] may experience intense pain at the moment of ejaculation. Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation. [[Urethritis]] or [[prostatitis]] can make genital stimulation painful or uncomfortable. Anatomic deformities of the penis, such as in [[Peyronie's disease]], may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection (Bancroft 1989). During vigorous intercourse or masturbation, small tears may occur in the frenum of the foreskin and can be very painful.
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Hemorrhoids]],  [[Renal nutcracker syndrome ]], [[Thrombosed piles]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Allergic contact dermatitis]], [[Healed perineal lacerations]],  [[Irritant contact dermatitis]],  [[Kraurosis vulvae]],  [[Lichen planus]],  [[Lichen sclerosus]],  [[Obstetric perineal injury]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Sjögren's syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Menopause]],  [[Perimenopause]],  [[Prolactin secreting pituitary tumour]],  [[Prolactinoma]],  [[Reduced estrogen]],  [[Reduced libido]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Inflammatory bowel disease ]],  [[Irritable bowel syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Congenital absence of lower part of vagina]],  [[Müllerian anomalies]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Episiotomy]],  [[Gynecologic surgery]],  [[Obstetric surgery]],  [[Vaginal surgery]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Parkinson’s disease]],  [[Vaginismus]],  [[Vulval dystrophy]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Parkinson’s disease]],  [[Peripheral neuropathies]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[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]],  [[Provoked vulvar pain]],  [[Remnants of the hymen]],  [[Salpingo-oophoritis]], [[Unruptured hymen]],  [[Vagina cancer]],  [[Vaginal abnormality]],  [[Vaginal dryness]],  [[Vaginal surgery]],  [[Vaginismus]],  [[Virilising ovarian tumour ]],  [[Vulva infection]],  [[Vulval dystrophy]],  [[Vulval neoplasia]],  [[Vulvar vestibulitis syndrome ]],  [[Vulvitis]],  [[Vulvodynia]],  [[Vulvovaginitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[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 ]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety]],  [[Depression]],  [[Psychological disorders]],  [[Reduced libido]],  [[Relationship dysfunction]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Interstitial cystitis]],  [[Renal nutcracker syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Arthritis of the hips]],  [[Fibromyalgia]],  [[Kraurosis vulvae]],  [[Lichen planus]],  [[Menopause]],  [[Scleroderma]],  [[Sicca syndrome]],  [[Sjögren's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Chlamydia]],  [[Estrogen-based contraceptives]],  [[Female genital mutilation]],  [[Genital ulcers]],  [[Gonorrhea]],  [[Herpes simplex virus]],  [[Herpes virus 2]],  [[Trichomonas vaginalis]],  [[Trichomonas]],  [[Trichomoniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Allen-masters syndrome ]],  [[Anal fissure]],  [[Cystitis]],  [[Trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Interstitial cystitis]],  [[Peyronie's disease]],  [[Urethral caruncle]],  [[Urethritis]],  [[Urinary tract infection]],  [[Uterine sarcoma ]],  [[Uterine tumour]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Relationship dysfunction]]
|-
|}


A rare form of male dyspareunia - postejaculatory pain syndrome - is characterized by persistent and recurring pain in the genital organs during ejaculation or immediately thereafter. The painful sensations are experienced as sharp, stabbing, and/or burning. Although the duration of pain is usually brief, it can persist and be quite intense. Although the immediate cause of psychogenic postejaculatory pain syndrome is the involuntary painful spasm or cramping of certain pain-sensitive muscles in the male genital and reproductive organs, the excruciatingly painful muscle cramps may be attributable to a man’s conflict about ejaculating. A pelvic floor disorder can also be the cause of pain during and after sex. Spasming, inflammed, overtoned or shortened pelvic muscles can result in the compression or sometimes the entrapment of the [[pudendal nerve]]. Guilt about sexual pleasure or about the paraphiliac nature of the erotic fantasies can lead to pain with orgasm. In other cases, men with liberal sexual attitudes might feel general resentment, or be angry at their current sexual partners for unconscious or conscious reasons.
===Causes in Alphabetical Order===
{{columns-list|3|
*[[Allen-masters syndrome]]
*[[Allergic contact dermatitis]]
*[[Anal fissure]]
*[[Anxiety]]
*[[Arthritis of the hips]]
*[[Atrophic vaginitis]]
*[[Atrophic vulvitis]]
*[[Atrophic vulvovaginitis]]
*[[Autoimmune endometriosis ]]
*[[Autoimmune interstitial cystitis ]]
*[[Bartholin gland cyst]]
*[[Bartholinitis]]
*[[Candida albicans]]
*[[Candidiasis]]
*[[Chlamydia]]
*[[Chronic pain syndromes]]
*[[Congenital absence of lower part of vagina]]
*[[Cystitis]]
*[[Depression]]
*[[Endometrial conditions]]
*[[Endometriosis]]
*[[Episiotomy]]
*[[Estrogen deficiency]]
*[[Estrogen-based contraceptives]]
*[[Female genital mutilation]]
*[[Fibromyalgia]]
*[[Functional disorders]]
*[[Genital system cancer]]
*[[Genital tract tumor]]
*[[Genital ulcers]]
*[[Gonorrhea]]
*[[Gynaecological conditions]]
*[[Gynecologic surgery]]
*[[Healed perineal lacerations]]
*[[Hemorrhoids]]
*[[Herpes simplex virus]]
*[[Herpes virus 2]]
*[[Imperforate hymen]]
*[[Inflamed hymeneal orifice]]
*[[Inflammatory bowel disease ]]
*[[Interstitial cystitis]]
*[[Irritable bowel syndrome]]
*[[Irritant contact dermatitis]]
*[[Kraurosis vulvae]]
*[[Lactation]]
*[[Leucoplakia]]
*[[Lichen planus]]
*[[Lichen sclerosus]]
*[[Menopause]]
*[[Müllerian anomalies]]
*[[Multiple sclerosis]]
*[[Myofascial pelvic pain syndrome]]
*[[Narrow vagina]]
*[[Obstetric perineal injury]]
*[[Obstetric surgery]]
*[[Ovarian tumour]]
*[[Parkinson’s disease]]
*[[Pelvic adhesions]]
*[[Pelvic disorders]]
*[[Pelvic infection]]
*[[Pelvic inflammatory disease]]
*[[Pelvic malignancy]]
*[[Pelvic organ prolapse]]
*[[Pelvic tumor]]
*[[Perimenopause]]
*[[Peripheral neuropathies]]
*[[Peyronie's disease]]
*[[Poor vaginal lubrication]]
*Post-childbirth
*[[Postmenopause]]
*[[Prolactin secreting pituitary tumour]]
*[[Prolactinoma]]
*[[Prolapsed tender ovaries with retroverted uterus]]
*[[Provoked vulvar pain]]
*[[Psychological disorders]]
*[[Reduced estrogen]]
*[[Reduced libido]]
*[[Relationship dysfunction]]
*[[Remnants of the hymen]]
*[[Renal nutcracker syndrome ]]
*[[Salpingo-oophoritis]]
*[[Scleroderma]]
*[[Sicca syndrome]]
*[[Sjögren's syndrome ]]
*[[Thrombosed piles]]
*[[Trauma]]
*[[Trichomonas]]
*[[Trichomonas vaginalis]]
*[[Trichomoniasis ]]
*[[Unruptured hymen]]
*[[Urethral caruncle]]
*[[Urethritis]]
*[[Urinary tract infection]]
*[[Uterine sarcoma ]]
*[[Uterine tumour]]
*[[Vagina cancer]]
*[[Vaginal abnormality]]
*[[Vaginal changes from childbirth]]
*[[Vaginal dryness]]
*[[Vaginal surgery]]
*[[Vaginismus]]
*[[Vaginitis]]
*[[Vestigial vagina]]
*[[Virilising ovarian tumour ]]
*[[Vulva infection]]
*[[Vulval dystrophy]]
*[[Vulval neoplasia]]
*[[Vulvar vestibulitis syndrome ]]
*[[Vulvitis]]
*[[Vulvodynia]]
*[[Vulvovaginitis]]
*[[Yolk sack tumour ]]
}}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
 
{{WS}}
[[Category:Obstetrics]]
[[Category:Needs overview]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Psychiatry]]
[[Category:Sexual and gender identity disorders]]
[[Category:primary care]]

Revision as of 18:48, 10 November 2016

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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.

Overview

Common causes of dyspareunia include localized infectious and congenital disorders of the vulva, vagina, and perianal regions. Additional causes include systemic conditions and diseases.

Causes

Common Causes

Causes by Organ System

Cardiovascular Hemorrhoids, Renal nutcracker syndrome , Thrombosed piles
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Allergic contact dermatitis, Healed perineal lacerations, Irritant contact dermatitis, Kraurosis vulvae, Lichen planus, Lichen sclerosus, Obstetric perineal injury
Drug Side Effect No underlying causes
Ear Nose Throat Sjögren's syndrome 
Endocrine Menopause, Perimenopause, Prolactin secreting pituitary tumour, Prolactinoma, Reduced estrogen, Reduced libido
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease , Irritable bowel syndrome
Genetic Congenital absence of lower part of vagina, Müllerian anomalies
Hematologic No underlying causes
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
Nutritional/Metabolic No underlying causes
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, Provoked vulvar pain, Remnants of the hymen, Salpingo-oophoritis, Unruptured hymen, Vagina cancer, Vaginal abnormality, Vaginal dryness, Vaginal surgery, Vaginismus, Virilising ovarian tumour , Vulva infection, Vulval dystrophy, Vulval neoplasia, Vulvar vestibulitis syndrome , Vulvitis, Vulvodynia, Vulvovaginitis
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 
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety, Depression, Psychological disorders, Reduced libido, Relationship dysfunction
Pulmonary No underlying causes
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, Peyronie's disease, Urethral caruncle, Urethritis, Urinary tract infection, Uterine sarcoma , Uterine tumour
Miscellaneous Relationship dysfunction

Causes in Alphabetical Order

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
3

References

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