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General Considerations
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Dyspareunia and vaginismus are two subcategories of sexual pain disorders
Dyspareunia is defined as recurrent or persistent genital pain associated with sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus and that causes marked distress or interpersonal difficulty
Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse, causing marked distress or interpersonal difficulty
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May be caused by vulvovaginitis, vulvar disease (including lichen planus, lichen sclerosus, and lichen simplex chronicus), pelvic disease (eg, endometriosis or chronic pelvic inflammatory disease), vulvodynia, or vaginal atrophy
Vulvovaginitis: inflammation or infection of the vagina
Vaginismus
Voluntary or involuntary contraction of muscles around the introitus
Results from fear, pain, sexual trauma, or having learned negative attitudes toward sex during childhood
Infection, endometriosis, tumors, or other pathologic conditions: pain occurring with deep thrusting during coitus is usually due to acute or chronic infection of the cervix, uterus, or adnexa; endometriosis; adnexal tumors; or adhesions resulting from prior pelvic disease or operation
Vulvodynia is the most frequent cause of dyspareunia in premenopausal women
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Differential Diagnosis
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Vulvodynia or vulvar vestibulitis
Vaginismus
Insufficient vaginal lubrication
Vulvovaginitis
Vulvar disease, including lichen planus, lichen sclerosus, and lichen simplex chronicus
Pelvic disease, such as endometriosis or chronic pelvic inflammatory disease
Vaginal atrophy
Ovarian tumor
Pelvic adhesions
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Diagnostic Procedures
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