These include dryness of the vagina, thinning of the vaginal walls for different reasons, reactions to some types of medication, scarring from childbirth, and skin conditions. All these can get worse during or after a gynecological examination, inserting a tampon, and vigorous sexual intercourse. Feeling pain during sex often happens during and after menopause, as the walls of the vagina get thinner and more sensitive, but younger women with low levels of the hormone estrogen are likely to experience similar symptoms. The estrogen hormone group plays a key role in vaginal health; low levels can cause increased sensitivity, and therefore discomfort. All of these sources of pain have predictable and often distressing consequences for the frequency and enjoyment of sex. More causes are discussed below. The doctor will have to rule out all other potential causes of genital pain before making a diagnosis of PVD.


Other potential causes


Once these plain physical causes have been ruled out, the doctor needs to consider other types of sexual dysfunction, which have symptoms very similar to PVD and are often difficult to separate. PVD is a lot like a condition called Vaginismus, and also like HSDD, or Hypoactive Sexual Desire Disorder: the medical term for loss of sexual interest. But a good doctor will be able to tell them apart because the symptoms occur in different patterns that allow for an accurate diagnosis.

With PVD, sex is painful without any identifiable cause, and penetration is difficult, if not impossible. The patient is typically worried and frustrated, and experiences an understandable loss of sexual desire, which in turn causes the relationship with her sexual partner to suffer.
In Vaginismus, involuntary muscle spasms make sex near-impossible and, if penetration is forced, it’s very painful. Again, this brings on loss of desire and inevitable relationship problems.

HSDD patients, by contrast, lose desire mostly in response to stressful situations or relationship problems. They no longer find erotic stimulation arousing, and their vaginas do not get lubricated, which, again, makes it difficult and painful to have sex, and in turn causes greater conflict and stress.
Because the causes of these three conditions are very different, they require dramatically different treatments. It is therefore very important for the doctor to get a clear history of the patient’s medical and sexual background, as well as the onset of the pain, and for the patients to be very honest about their experiences so far.
Patients who suffer from genital pain with no recognizable origin need to be evaluated carefully, because they often suffer from more than one condition; something we call “association”. It means that painful conditions with no obvious physical cause accumulate either in one patient or – even more strangely - in family clusters, following a hereditary pattern.


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