Dyspareunia in Young Patients: Cited Causes and Considerations

Primary Causes and Diagnostic Considerations

Postpartum dyspareunia affects approximately 35% of women after childbirth, with 43% experiencing pain at 2-6 months postpartum, 22% at 6-12 months, and 40% at 12-24 months, according to The Lancet Global Health 1
Postpartum causes include perineal trauma, episiotomy scars, vaginal dryness from breastfeeding-induced hypoestrogenism, and pelvic floor dysfunction, as noted in The Lancet Global Health 1
Pelvic floor muscle dysfunction can cause both superficial and deep dyspareunia, with tender pelvic floor muscles identifiable on single-digit vaginal examination, as reported in the Journal of Clinical Oncology 2 and 3
Lichen sclerosus presents with porcelain-white papules and plaques, causing dyspareunia through erosions, fissures, or introital narrowing, and has a bimodal distribution affecting prepubertal girls and postmenopausal women, according to the British Journal of Dermatology 4, 5, and 6
Estrogen deprivation from hormonal contraceptives, breastfeeding, or premature ovarian insufficiency causes vaginal atrophy, dryness, and dyspareunia, as noted in Annals of Oncology 7, 8, and Ca-A Cancer Journal for Clinicians 9
Young cancer survivors treated with chemotherapy, radiation, or endocrine therapy frequently experience dyspareunia from vaginal dryness, scarring, and hormonal changes, as reported in the Journal of Clinical Oncology 2, 3, and 10

Do not overlook lichen sclerosus in young patients, as it has a prepubertal peak and may be asymptomatic or mistaken for other conditions, according to the British Journal of Dermatology 4, 5, and 6
Do not dismiss postpartum dyspareunia as normal or temporary, as it persists beyond 12 months in 40% of affected women and requires specific treatment, as noted in The Lancet Global Health 1

Pelvic pain experienced after intercourse is a component of dyspareunia, affecting women after sexual activity 11
Approximately 35% of postpartum women experience dyspareunia, with the timing of pain varying significantly: 43% at 2-6 months postpartum, 22% at 6-12 months, and 40% at 12-24 months 11

The National Comprehensive Cancer Network (NCCN) Guidelines address "symptoms of pain with sexual activity", recommending treatments including ospemifene, pelvic physical therapy, topical anesthetics, yoga, and meditation 12, 13