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  • Painful intercourse
  • Urogential 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, not elsewhere classified
    • 728.85 Spasm of muscle
    • 729.1 Myalgia and myositis, unspecified

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


  • 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


  • 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

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

Laboratory Tests

  • 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


  • All tests to rule out other pathology
    • Cystoscopy
    • Ultrasound
    • ...

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