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  • Painful intercourse

  • Urogenital pain disorders

  • Sexual pain disorder

  • Levator ani syndrome

  • Vaginismus


  • 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

    • 728.85 Spasm of muscle

    • 729.1 Myalgia


  • M62.83 Muscle spasm

  • M79.1 Myalgia

  • N94.1 Dyspareunia

  • N94.2 Vaginismus


  • 4C: Impaired Muscle Performance1


A 28-year-old woman delivered her first baby vaginally 12 weeks ago. She sustained a Grade 2 perineal wound during the delivery. The wound became infected. The wound was surgically repaired and revised during a subsequent surgery. The obstetrician (OB) told the patient that some of the perineal scar tissue had to be removed. She was cleared by her OB/gynecologist (Gyn) to have intercourse but experienced severe pain during initial penetration and also with deep penetration during the first attempt at intercourse with her husband.



  • Pain during initial or deep penetration during sexual intercourse

Essentials of Diagnosis

  • Rule out gynecological pathology

  • Pain with vaginal penetration during gynecological examination, 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 (PFMs)

FIGURE 268-1

Diagnostic approach: Vaginitis. PID, pelvic inflammatory disease; TSS, toxic shock syndrome. (From Henderson MC, Tierney LM, Smetana GW. The Patient History: An Evidence-Based Approach to Differential Diagnosis. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

General Considerations

  • Female 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


  • 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



  • 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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