A woman may experience difficult or painful intercourse (dyspareunia) because of a number of reasons. Identification of the cause is the basis for future management.


Possible causes of dyspareunia:

(1) vaginismus

(2) genital or urinary tract infection

(3) vulvar vestibulitis

(4) vaginal dryness secondary to estrogen deficiency

(5) pelvic or genital trauma

(6) episiotomy, genital surgery or complications of childbirth

(7) radiation therapy

(8) decreased arousal with poor lubrication

(9) tensing of the pelvic floor muscles

(10) endometriosis

(11) contact allergy

(12) topical irritant

(13) drugs that reduce lubrication

(14) congenital malformation

(15) tumors


Causes of estrogen deficiency:

(1) post-menopausal

(2) after bilateral oopherectomy

(3) medications resulting in chemical castration


Causes of decreased arousal:

(1) diabetes mellitus

(2) multiple sclerosis

(3) spinal cord injury

(4) absence of foreplay by the partner


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