Pathogenesis (development of disease)
Dyspareunia occurs relatively frequently. The underlying cause may be somatic (physical) or psychological. The sensitivity of the urinary bladder, pelvic floor, cervix (neck of the uterus), and uterus (womb) also plays a role in pain intensity. According to the localization, an “external” dyspareunia is distinguished from an “internal” dyspareunia. Pain physiologically, the condition may be based on neuropathic pain or neurogenic inflammation.
Etiology (causes)
Biographic causes
- Teenagers and post-menopausal women (localization: “external” dyspareunia).
- Middle-aged women (localization: “internal” dyspareunia).
- Hormonal factors – estrogen deficiency in climacteric / menopause.
Behavioral causes
- Psycho-social situation
- Rejection of the partner
- Relationship problems
- Psychological conflicts
- Lack of sexual arousal
Disease-related causes (organic causes or differential diagnoses, i.e., a diagnosis of exclusion is required).
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).
- Gartner cysts (synonym: Gartner duct cyst; cysts of the vaginal wall that form from the tissue of Gartner’s duct, a relic of the ductus mesonephricus) – Location: usually in the anterolateral (“front and side”) region of the upper 2/3 of the vagina (vagina); Symptomatology: usually nonspecific and dependent on the size of the cyst; Incidence: 1-2% of all women.
Skin and subcutaneous (L00-L99).
- Lichen sclerosus (LS) (et atrophicus) – rarely occurring, chronic disease of connective tissue, which is probably one of the autoimmune diseases.
Cardiovascular system (I00-I99).
- Pelvic congestion syndrome (PCS) – chronic abdominal pain in women.
- Thrombosed hemorrhoid
Infectious and parasitic diseases (A00-B99).
- Gonorrhea (gonorrhea) – sexually transmitted infectious disease.
- Trichomonad colpitis – vaginitis caused by trichomonads (protozoa – single-celled organisms).
Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).
- Anal fissure – painful tearing of the skin or mucous membrane of the anus.
- Chronic inflammatory bowel disease (IBD): ulcerative colitis, Crohn’s disease.
- Perianal abscess – purulent inflammation in the tissue around the anus (anus).
- Irritable bowel syndrome (IBS)
Neoplasms – tumor diseases (C00-D48)
- Cervical carcinoma (cervical cancer).
- Ovarian cysts and benign neoplasms of the ovary (ovary).
Psyche – Nervous System (F00-F99; G00-G99).
- Neuromas following episiotomy (nerve tangle formations at the end of an injured nerve; in this case, following episiotomy (perineal incision)).
Pregnancy, childbirth, and puerperium (O00-O99).
- Births – due to scars (episiotomy/perineal tear).
Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).
- Adenomyosis (adenomyosis uteri) – endometrial islets (endometrial islets) within the myometrium/uterine muscles (endometriosis uteri).
- Adnexitis (ovarian inflammation), chronic.
- Atrophic colpitis (colpitis senilis; estrogen deficiency colpitis; vaginal dryness) – vaginitis in menopausal and postmenopausal women.
- Bartholinitis – inflammation of the excretory ducts of the Bartholinian gland.
- Cervicitis (inflammation of the cervix).
- Endometriosis – appearance of endometrium (endometrium) outside the uterine cavity (cavum uteri).
- Genital prolapse – partial or complete prolapse of the vagina (descensus vaginae) and / or uterus (descensus uteri) from the pubic cleft (rima pudendi).
- Pelvipathy – lower abdominal pain in women due to very different causes, which can be somatic (physical) as well as psychological nature.
- Premenstrual syndrome (PMS) – occurs in women about four to fourteen days before the next period and involves a complex picture of different symptoms and complaints.
- Overactive bladder (OAB symptoms).
- Uterine fibroids – benign growths of the uterus.
- Urethritis (inflammation of the urethra)
- Urethral caruncle – mucosal protrusion of the female urethra.
- Vaginal mycoses (fungal infections of the vagina).
- Vaginismus – spastic closure of the vagina (vagina), usually caused by psychological problems.
- Vaginitis / colpitis (vaginitis; bacterial, mycosis, trichomonads).
- Vulvar vestibulitis (vestibulitis vulvae syndrome; localized vulvar dysesthesia) – the most common form of superficial (introital) dyspareunia.
- Vulvitis – inflammation of the external genital organs.
- Cystitis (inflammation of the bladder)
Medication
- Anti-hormonal therapy (ovarian ablation with GnRH analogs to the use of aromatase inhibitors) → therapy-induced estrogen deprivation in hormone receptor-positive breast carcinoma patients → pronounced vaginal atrophy and shift in pH with changes in vaginal flora → dyspareunia, possibly also cohabitation incapacity.
Operations
- Adhesions (adhesions) after abdominal surgery.
- Obstetric surgery: Patients with postsectio caesarea (cesarean section) or vacuum extraction (vacuum cup delivery) conditions are at higher risk for postpartum (“occurring after delivery”) dyspareunia, compared with patients who delivered spontaneously and whose perineum was not injured.
- Operations on the rectum (rectal).
- Female Genital Mutilation (FGM): Clitoridectomy; circumcision of the labia majora (excision); circumcision of the labia majora and removal of the externally visible part of the clitoris (infibulation).
Further
- Intact hymen
