Etiology

The etiology of dyspareunia differs depending on whether the pain is associated with the external genitalia (superficial dyspareunia) or with deeper pelvic structures (deep dyspareunia).[9]

Etiologies of superficial dyspareunia

  • Inflammatory dermatologic conditions: atopic dermatitis, contact dermatitis (due to latex, spermicides, or seminal plasma allergy), any other dermatologic condition involving the vulva or vagina

  • Infectious conditions: vulvovaginitis, herpes simplex outbreak, interstitial cystitis, or urinary tract infection

  • Mucosal dysfunction: iatrogenic causes such as pelvic radiation or prescription of medications that decrease lubrication (e.g., birth control pills, antidepressants, some antihypertensives); primary inadequate lubrication; vaginal atrophy due to menopause

  • Structural abnormalities (leading to obstruction): imperforate hymen, Bartholin mass/abscess, vulvar dystrophies, perineal injury including episiotomy or obstetric trauma, and female genital mutilation/cutting

  • Musculoskeletal disorders: vaginismus (due to a conditioned reflex of the pubococcygeus muscle, the muscles in the vagina tense suddenly in response to any form of vaginal penetration, therefore making sexual intercourse or pelvic examination painful or impossible)

  • Other disorders: psychosexual, vestibulodynia/vulvodynia (chronic burning and/or pain involving the introitus without obvious medical cause; may occur with associated fissures in the surrounding skin).

Etiologies of deep dyspareunia

  • Infectious/inflammatory conditions: cervicitis, pelvic inflammatory disease, endometriosis (presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature; can cause deep dyspareunia by distortion of pelvic anatomy and rectovaginal involvement), hydrosalpinx (collection of fluid in the fallopian tubes, causing blockage of the tubes; can follow infectious conditions)

  • Structural abnormalities: leiomyomata (also known as uterine fibroids, benign tumors of the uterus primarily composed of smooth muscle and fibrous connective tissue; range in size from seedlings to large uterine tumors), adenomyosis (ectopic endometrial tissue found in the myometrium, the thick muscular layer of the uterus, leading to local excretion of cytokines, which induce pain)

  • Musculoskeletal disorders: levator ani spasm (episodic rectal pain with unknown etiology).

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