Differential Diagnosis in Primary Care, 4th Edition

Dyspareunia

Painful introduction of the male organ or pain during intercourse are both considered under this title. The mnemonic to use here is MINT. This can then be applied to the anatomic structures as we explore the genital tract. Of course, psychologic disturbances are probably the most common causes of this disorder. They are discussed after the anatomic causes.

Dyspareunia

·     M—Malformations include a disproportionately large or deformed male organ (not amusing to the man in this predicament), an unruptured or thick hymen, vaginal stenosis, a retroverted uterus, and prolapsed ovaries.

·     I—Inflammatory disorders include vulvitis and bartholinitis (often related to gonorrhea), various forms of vaginitis (bacterial, trichomoniasis, and moniliasis), and salpingo-oophoritis. (Note that an inflamed uterus and cervix are only infrequently associated with dyspareunia.) Inflammatory lesions of nearby structures are important. Thus, a urethral carbuncle, urethritis, cystitis, hemorrhoids, and anal fissures can cause dyspareunia.

·     N—Neoplasms causing dyspareunia are leukoplakia vulvitis, kraurosis vulvae, carcinoma of the vulva and vagina, ovarian cysts, and carcinoma. When uterine and cervical carcinomas extend beyond the genital tract, dyspareunia is present. Any neoplasm of the bladder and rectum that has extended into the genital tract will undoubtedly cause dyspareunia.

·     T—Traumatic disorders include too-frequent intercourse and masturbation. Introduction of the male organ before adequate foreplay has created a lubricated vagina is another cause. The male patient should be instructed in the gentle introduction of the organ.

Women in menopause may require lubricants to prevent local trauma, because the vagina remains dry even after sexual excitement because of lack of hormonal secretion.

Discovery of psychogenic causes often requires thorough psychoanalysis. A careful evaluation for sexual abuse must be done. Incest, guilt from masturbation, and latent homosexuality are a few of the problems that may be encountered.

Approach to the Diagnosis

The approach to this diagnosis includes an examination of both male and female genital organs and counseling by an understanding physician if these examinations are negative.

Other Useful Tests

1. Pregnancy test

2. Vaginal smear and culture

3. Urinalysis and culture

4. Sonogram (ectopic pregnancy, ovarian cyst, tubo-ovarian abscess)

5. Laparoscopy

6. Gynecology consult

7. Psychiatric consult



If you find an error or have any questions, please email us at admin@doctorlib.info. Thank you!