Dyspareunia differential diagnosis: Difference between revisions

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__NOTOC__
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{{Dyspareunia}}
{{Dyspareunia}}
{{CMG}} {{AE}} {{VVS}}; {{JH}}
{{CMG}} {{AE}} {{VVS}}; {{JH}}


==Differential Diagnosis==
==Overview==
*[[Endometriosis]]
Genito-pelvic/penetration disorder(GPPPD) must be differentiated from other medical causes of dyspareunia.
*[[Erectile dysfunction]] in the male
*Inadequate sexual stimuli
*[[Lichen sclerosus]]
*[[Pelvic inflammatory disease]]
*Premature ejaculation in the male
*[[Vaginal dryness]]
*Vulvovaginal atrophy<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref>


==Differentiating Dysparenia from other Diseases==
==Differentiating GPPPD from Other medical causes of dyspareunia in females==
Complaints of sexual pain - that is, dyspareunia or [[vulvodynia]] - typically fall into one of three categories - vulvar pain (pain at the opening or at the external genitalia), vaginal pain, or deep pain - or some combination of all three. There is some evidence for the existence of several subtypes of dyspareunia (Binik et al. 2000): vulvar vestibulitis (the most common type of premenopausal dyspareunia), vulvar or [[vaginal atrophy]] (which typically occurs postmenopausally), and deep dyspareunia or pelvic pain (associated with such gynecological conditions as [[endometriosis]], [[ovarian cyst]]s and pelvic adhesions, inflammatory disease, or congestion).
Possible medical causes of dyspareunia should be ruled out or treated before considering a diagnosis of "Genito-Pelvic  Pain/Penetration  Disorder". GPPPD is actually an umbrella term for two sexual pain disorders:dyspareunia and vaginismus. (see the following table for differential diagnosis in females)
 
{|style="width:80%; height:100px" border="1"
Vulvar vestibulitis syndrome (VVS) is the most common subtype of vulvodynia affecting premenopausal women. It tends to be associated with a highly localized “burning” or “cutting” type of pain. The feelings of irritation and burning can persist for hours or days following sexual activity, engendering a sense of hopelessness and [[depression]] (Bergeron et al. 1997; Marinoff and Turner 1991; Peckham et al. 1986).
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
 
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Hemorrhoids]],[[Anal fissure]],  [[Renal nutcracker syndrome ]],  [[Thrombosed piles]]
The prevalence of VVS is quite high: the syndrome has been cited as affecting about 10%-15% of women seeking gynecological care (Bergeron et al. 1997). It is characterized by severe pain with attempted penetration of the vaginal introitus and complaints of tenderness with pressure within the vulvar vestibule. Usually there are no reports of pain with pressure to other surrounding areas of the vulva. Diagnosis is readily made by the cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. Laboratory tests are used to exclude bacterial or viral infection, and a careful examination of the vulvo/vaginal area is conducted to assess whether any [[atrophy]] is present.
|-
 
|-bgcolor="LightSteelBlue"
VVS involves multiple tiny erythematous sores in the vulvar vestibule (Friedrich 1987; Marinoff and Turner 1991). A number of etiological factors may be involved, including subclinical [[human papillomavirus]] infection, chronic recurrent [[candidiasis]], or chronic recurrent bacterial [[vaginosis]] (Marinoff and Turner 1991; Peckham et al. 1986). Muscular causes have been implicated as well, since chronic vulvar pain may be the result of chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some investigators have postulated the existence of neurological causes such as vestibular neural [[hyperplasia]]. Finally, psychological factors may contribute to or exacerbate the problem, since the anticipation of pain often results in a conditioned spasmodic reflex along with sexual desire and arousal problems. Relationship problems are generally the result of chronic frustration, disappointment, and depression associated with the condition.
| '''Dermatologic'''
 
|bgcolor="Beige"| [[Allergic contact dermatitis]],  [[Healed perineal lacerations]],  [[Irritant contact dermatitis]],  [[Kraurosis vulvae]],  [[Lichen planus]],  [[Lichen sclerosus]], [[Obstetric perineal injury]]
[[Vaginal atrophy]] as a source of dyspareunia is most frequently seen in postmenopausal women and is generally associated with estrogen deficiency. [[Estrogen]] deficiency is associated with lubrication inadequacy, which can lead to painful friction during intercourse.
|-
 
|-bgcolor="LightSteelBlue"
In women with VVS and vulvar/vaginal atrophy, the pain is associated with penetration or with discomfort in the anterior portion of the vagina. There are some women, however, who report deeper vaginal or pelvic pain. Little is known about these types of pain syndromes, except that they are thought to be associated with gynecological conditions such as endometriosis, ovarian cysts, pelvic adhesions, or inflammatory disease.
| '''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"
| '''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"
| '''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"
| '''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]],  [[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]], Provoked vestibulodynia,
|-
|-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"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety]], [[Depression]], [[Psychological disorders]], [[Reduced libido]], [[Relationship dysfunction]]
|-
|-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]], [[Urethral caruncle]], [[Urethritis]], [[Urinary tract infection]], [[Uterine sarcoma ]], [[Uterine tumour]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Relationship dysfunction]]
|-
|}


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

Latest revision as of 05:22, 26 September 2020

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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]; Jesus Rosario Hernandez, M.D. [3]

Overview

Genito-pelvic/penetration disorder(GPPPD) must be differentiated from other medical causes of dyspareunia.

Differentiating GPPPD from Other medical causes of dyspareunia in females

Possible medical causes of dyspareunia should be ruled out or treated before considering a diagnosis of "Genito-Pelvic Pain/Penetration Disorder". GPPPD is actually an umbrella term for two sexual pain disorders:dyspareunia and vaginismus. (see the following table for differential diagnosis in females)

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, 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

References

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