Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Painful intercourseUrogential pain disordersSexual pain disorderLevator ani syndromeVaginismus ++ 625.0 DyspareuniaAssociated diagnoses617 Endometriosis625.1 Vaginismus625.7 Vulvodynia625.71 Vulvar vestibulitis724.7 Disorders of coccyx728.2 Muscular wasting and disuse atrophy, not elsewhere classified728.85 Spasm of muscle729.1 Myalgia and myositis, unspecified ++ M62.83 Muscle spasmM79.1 MyalgiaN94.1 DyspareuniaN94.2 Vaginismus ++ Pattern: 4C impaired muscle performance1 +++ Description ++ Pain during initial or deep penetration during sexual intercourse +++ Essentials of Diagnosis ++ Rule out gynecological pathologyPain with vaginal penetration during gynecological exam, insertion of tampon, or during and after sexual intercoursePain to palpation of the superficial genital muscles and/or deep levator ani pelvic floor muscles +++ General Considerations ++ Affects females onlyMay be a side effect of vaginal delivery associated with perineal trauma or pelvic joint injuryVaginal stenosis and atrophy causing painful intercourse may be secondary to radiation of the pelvis for treatment of cancersUrogenital 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 births2Exact prevalence of pelvic pain is not known, estimates vary in the literature from 3.8% to 24%3Many 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 +++ Signs and Symptoms ++ Report of vaginal pain during penetrationPerceived reduction in size of vaginal opening attributed to muscle spasmMay complain of lower quadrant abdominal pain during sexual intercourseSymptoms may worsen or decrease during and after sexual intercourse +++ Functional Implications ++ Pain during attempted penetrationSexual dysfunctionMay lead to unwanted abstinenceMay lead to decision to not have a subsequent pregnancy +++ Possible Contributing Causes ++ Perineal trauma during vaginal deliveryCoccyx injury or fracturePubic symphysis diastasisUrinary tract infectionHistory of sexual or physical abuseStress, anxietyFear, catastrophizing +++ Differential Diagnosis ++ Urinary tract infection (UTI)Sexually transmitted diseaseUrethritisBladder infectionYeast infectionBacterial vaginosisOrgan dysfunction from cancer or malignancyNon-malignant tumor in abdomen or organsGynecologic problems in femalesEndometriosisMensesEctopic pregnancyOvarian cystFibroidsMenopauseAppendicitisPelvic inflammatory disease +++ Laboratory Tests ++ To rule out other pathologyBlood tests to rule out pathologyUrine culture/urinalysis to rule out infectionH&H for signs for bleeding, anemia, pathogens, immune status, vitamin deficiencies, white blood cell count +++ Imaging ++ All tests to rule out other pathologyCystoscopyUltrasound... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.