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  • Painful intercourse
  • Urogential pain disorders
  • Sexual pain disorder
  • Levator ani syndrome
  • Vaginismus

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  • 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

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  • M62.83 Muscle spasm
  • M79.1 Myalgia
  • N94.1 Dyspareunia
  • N94.2 Vaginismus

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Description

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  • Pain during initial or deep penetration during sexual intercourse

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Essentials of Diagnosis

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  • 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

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General Considerations

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  • 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

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Demographics

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  • 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

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Signs and Symptoms

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  • 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

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Functional Implications

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  • Pain during attempted penetration
  • Sexual dysfunction
  • May lead to unwanted abstinence
  • May lead to decision to not have a subsequent pregnancy

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Possible Contributing Causes

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  • 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

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Differential Diagnosis

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  • 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

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Laboratory Tests

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  • To rule out other pathology
    • Blood tests to rule out pathology
    • Urine culture/urinalysis to rule out infection
    • H&H for signs for bleeding, anemia, pathogens, immune status, vitamin deficiencies, white blood cell count

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Imaging

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  • All tests to rule out other pathology
    • Cystoscopy
    • Ultrasound
    • CT
    • Bladder scans
    • MRI
    • Xray

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Diagnostic Procedures

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