Skip to Main Content

++

Condition/Disorder Synonyms

++

  • Painful intercourse

  • Urogential pain disorders

  • Sexual pain disorder

  • Levator ani syndrome

  • Vaginismus

++

ICD-9-CM Codes

++

  • 625.0 Dyspareunia

  • Associated diagnoses

    • 617 Endometriosis

    • 625.1 Vaginismus

    • 625.7 Vulvodynia

    • 625.71 Vulvar vestibulitis

    • 724.7 Disorders of coccyx

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.85 Spasm of muscle

    • 729.1 Myalgia and myositis, unspecified

++

ICD-10-CM Codes

++

  • M62.83 Muscle spasm

  • M79.1 Myalgia

  • N94.1 Dyspareunia

  • N94.2 Vaginismus

++

Preferred Practice Pattern

++
++

Key Features

++

Description

++

  • Pain during initial or deep penetration during sexual intercourse

++

Essentials of Diagnosis

++

  • Rule out gynecological pathology

  • Pain with vaginal penetration during gynecological exam, insertion of tampon, or during and after sexual intercourse

  • Pain to palpation of the superficial genital muscles and/or deep levator ani pelvic floor muscles

++

General Considerations

++

  • Affects females only

  • May be a side effect of vaginal delivery associated with perineal trauma or pelvic joint injury

  • Vaginal stenosis and atrophy causing painful intercourse may be secondary to radiation of the pelvis for treatment of cancers

  • Urogenital pain disorders are frequently associated with pain in nearby body areas; especially back, pelvic, hip, groin regions

++

Demographics

++

  • Severe perineal trauma occurs in 0.5% to 10% of vaginal births2

  • Exact prevalence of pelvic pain is not known, estimates vary in the literature from 3.8% to 24%3

  • Many patients with pelvic pain will go on to develop chronic pain syndrome with depression, pain out of proportion to pathology, and changing roles in marriage, family, and career4

++

Clinical Findings

++

Signs and Symptoms

++

  • Report of vaginal pain during penetration

  • Perceived reduction in size of vaginal opening attributed to muscle spasm

  • May complain of lower quadrant abdominal pain during sexual intercourse

  • Symptoms may worsen or decrease during and after sexual intercourse

++

Functional Implications

++

  • Pain during attempted penetration

  • Sexual dysfunction

  • May lead to unwanted abstinence

  • May lead to decision to not have a subsequent pregnancy

++

Possible Contributing Causes

++

  • Perineal trauma during vaginal delivery

  • Coccyx injury or fracture

  • Pubic symphysis diastasis

  • Urinary tract infection

  • History of sexual or physical abuse

  • Stress, anxiety

  • Fear, catastrophizing

++

Differential Diagnosis

++

  • Urinary tract infection (UTI)

  • Sexually transmitted disease

  • Urethritis

  • Bladder infection

  • Yeast infection

  • Bacterial vaginosis

  • Organ dysfunction from cancer or malignancy

  • Non-malignant tumor in abdomen or organs

  • Gynecologic problems in females

    • Endometriosis

    • Menses

    • Ectopic pregnancy

    • Ovarian cyst

    • Fibroids

    • Menopause

  • Appendicitis

  • Pelvic inflammatory disease

++

Means of Confirmation or Diagnosis

++

Laboratory Tests

++

  • To rule out other pathology

    • Blood tests to rule out pathology

    • Urine culture/urinalysis ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.