Painful intercourse Assessment Questionnaire

Why: to determine if acute or chronic and to determine if related to first penetrative sexual intercourse.

Why: (i.e. around the vulva and vagina on penetration) or deep in the pelvis? - If pain is superficial, this usually suggests a vulval or vaginal origin such as bartholinitis, vulvitis, vulval dystrophy, cystitis (bladder infection), urethritis and urethral caruncle. If pain is deep, this may suggest salpingo-oophoritis (infection of the ovary and tube), retroverted uterus, endometriosis or ovarian cyst.

Why: the cause may by psychological or due to local trauma (such as tears to the hymen, laceration of the vaginal opening or bruising of the urethral opening). After these injuries painful superficial ulcers may develop. Other causes include inadequate lubrication (usually due to improper or insufficient foreplay), irritation due to improperly fitted condom or inadequately lubricated condom, allergic reaction to the contents of contraceptive foams or an abnormality of the genital tract (such as congenital septum or a rigid hymen).

Why: Some possible causes of painful intercourse for men include an unlubricated partner, penile skin infection, penile Candida infection, genital herpes, Peyronie's disease and prostatitis.

Why: e.g. Menopause may be associated with a dry vagina, atrophic vaginitis (dryness and thinning of the vaginal walls) and increased risk of Candida infections which may all cause painful intercourse.

Why: may suggest vaginismus or sexually transmitted infection as cause of painful intercourse.

Why: A painful episiotomy scar or vaginal repair may cause painful intercourse.

Why: e.g. hygiene products, laundry detergents, soaps, latex condoms.

Why: e.g. diabetes, obesity, AIDS, Sjogren's syndrome, Severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome, polyendocrine deficiency syndrome type 1, bone marrow transplant can predispose to Candida infections.

Why: e.g. corticosteroids, cancer cytotoxic drugs, antibiotics, oral contraceptives can predispose to Candida infections.

Why: e.g. soaps, laundry detergents, hygiene products, latex allergy from latex condoms.

Why: Dryness of the vagina may cause painful intercourse. Vaginal dryness may be due to inadequate foreplay, poor sexual technique, sexual anxiety, menopause, recent childbirth (due to both reduced libido and physical vaginal injuries), breast feeding (due to reduced hormone levels), Sjogren's syndrome and scleroderma.

Why: e.g. palpitations, hot flushes, night sweats, lightheadedness, dry skin, dry vagina, mood change. The estrogen withdrawal in menopause causes atrophic vaginitis (thinning and dryness of the vaginal skin) which predisposes to vaginal candidiasis and genital itch.

Why: may suggest pelvic inflammatory disease (may be an offensive, pus-like vaginal discharge), Candida vaginal infection (usually white curd like vaginal discharge), trichomoniasis vaginal infection, Chlamydia or gonorrhea vaginal infections.

Why: may suggest urethritis (due to Chlamydia or gonorrhea) or cystitis (infection of the bladder).

Why: usually suggest herpes simplex virus 1 or 2, usually painful. Less common causes of genital ulcers include syphilis (primary chancre of treponema pallidum often painless), chancroid (Haemophilus decreyi, usually painful), donovanosis (granulomona inguinale due to calymmatobacterium granulomatis, relatively painless) and lymphogranuloma venereum (due to Chlamydia trachomatis, usually painless).

Why: may suggest acute pelvic inflammatory disease or cystitis (bladder infection).

Why: e.g. missed menstrual periods, breast enlargement, breast tenderness, urinary frequency, nausea - may suggest ectopic pregnancy as cause of painful intercourse.

Why: e.g. involuntary tightening of the muscles that surround the vaginal opening and lower part of the vagina which prevents intercourse. Most cases are due to psychological causes such as inadequate or faulty sex education, sexual assault during childhood or due to a painful initial experience of sexual intercourse.

Why: e.g. pelvic pain which may start 1-2 weeks before the period and then reduces with the onset of the period, pain with intercourse, infertility or subfertility, heavy periods and non-specific pelvic pain.

Why: e.g. ache or discomfort in lower abdomen or pelvis with a sensation of pelvic heaviness. May be associated with menstrual period dysfunction, pain with intercourse and/or pain with menstruation.

Why: e.g. fever (if acute infection) , mild to severe lower abdominal pain, pain with intercourse, painful heavy or irregular periods, bleeding in-between the periods, abnormal and perhaps offensive pus-like vaginal discharge, painful or frequent urination.

Why: e.g. sudden onset of pain in one or the other sides of the pelvis. Usually occurring just prior to ovulation (just prior to day 14) or following sexual intercourse. There may be associated nausea and vomiting. The pain usually settles within a few hours.

Why: e.g. red, tender swelling within the posterior (back part) of the labia majora (the large rounded fold surrounding the vagina). May be due to non-sexually transmitted infection with E.Coli or Staphylococci bacteria; or a sexually transmitted infection with gonorrhea.

Why: e.g. with the first attack there is a tingling or burning feeling in the genital area, then a crop of small vesicles appear and then burst after 24 hours to leave small red painful ulcers which then form scabs and heal. The glands in the groin can become swollen and tender and the person may feel unwell and have a fever. May have difficulty or pain with passing urine. With recurrent attacks, symptoms usually become milder.

Why: onset often abrupt, usually the week before the menstruation and symptoms may recur before each menstruation. Symptoms may include genital itch, vaginal discharge, vaginal soreness, vulvar burning, painful intercourse and stinging of the urine.

Why: e.g. frequency of urination, excessive thirst, weight loss, fatigue, increased infections - Diabetes is a major risk factor for vaginal candidiasis.

Why: e.g. dry eyes, dryness of the mouth, skin or vagina. This syndrome may be associated with many systemic conditions such as Raynaud's phenomenon, difficulty in swallowing (as seen in systemic sclerosis), painful joints (like that seen with systemic lupus erythematosus), thyroid disease, myasthenia gravis, primary biliary cirrhosis, chronic active hepatitis, renal diabetes insipidus, renal tubular acidosis and vasculitis.