- Lack of vaginal lubrication?
Why: Dryness of the vagina may cause sexual pain. 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.
- Menopausal symptoms?
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.
- Vaginal discharge?
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.
- Pain with urination?
Why: may suggest urethritis (due to Chlamydia or gonorrhea) or cystitis (infection of the bladder).
- Genital ulcers?
Why: usually suggest herpes simplex virus 1 or 2. 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).
- Fever?
Why: may suggest acute pelvic inflammatory disease or cystitis (bladder infection).
- Symptoms of pregnancy?
Why: e.g. missed menstrual periods, breast enlargement, breast tenderness, urinary frequency, nausea - If associated with sexual pain must consider ectopic pregnancy.
- Symptoms of vaginismus?
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.
- Symptoms of endometriosis?
Why: e.g. pelvic pain which may start 1-2 weeks before the period and then reduces with the onset of the period. Also associated with pain with intercourse, infertility or subfertility, heavy periods and non-specific pelvic pain.
- Symptoms of malignant ovarian tumor?
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.
- Symptoms of pelvic inflammatory disease?
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.
- Symptoms of a ruptured ovarian cyst?
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.
- Symptoms of Bartholin's gland abscess?
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.
- Symptoms of genital herpes?
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.
- Symptoms of vaginal candidiasis?
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.
- Symptoms of Diabetes?
Why: e.g. frequency of urination, excessive thirst, weight loss, fatigue, increased infections - Diabetes is a major risk factor for vaginal candidiasis.
- Symptoms of Sjogren's syndrome?
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.
- Symptoms of Peyronie's disease?
Why: e.g. pain and crooked deformity of the penis with erections; abnormal curvature of the erect penis.
- Symptoms of Priapism?
Why: e.g. prolonged painful erection occurs, usually not associated with sexual stimulation. May be associated with leukemia, metastatic cancer, sickle cell anemia or trauma. In most cases, the cause is unknown Symptoms of paraphimosis? - e.g. foreskin is retracted, tight, swollen and painful. Typically occurs when the penis is erect.
- Symptoms of prostate cancer?
Why: e.g. pain with urination, weak urine stream, urinary retention (unable to urinate), urinary tract infection, erectile difficulty, pain with ejaculation, symptoms of metastases (weight loss, bone pain, numbness or weakness in legs).
- Symptoms of cancer of the penis?
Why: e.g. blood stained or foul smelling discharge from a lesion on the penis. The lesion is usually a nodular warty growth or an ulcer which may be painful especially if it is infected. There may also be enlarged lymph nodes in the groin. Cancer of the penis is rarely seen in uncircumcised men.
