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| | THE MERCK MANUAL OF GERIATRICS, Ch. 116, Sexual Dysfunction in Women |
 | | Causes include inadequate vaginal lubrication, irritation and dryness of the external genitalia, vulvovaginitis, local trauma (eg, episiotomy scars), urethritis, improper intromission (angle of entry), anorectal disease, altered anatomy of the female genital tract (eg, a retroverted or prolapsed uterus), and even arthritis. |
 | | Determining if dyspareunia occurs during foreplay, intromission, deep penetration, or certain positions can help in the differential diagnosis. |
 | | For example, dyspareunia during deep penetration may indicate lesions of the uterus or broad ligament. |
| www.merck.com /mrkshared/mmg/sec14/ch116/ch116e.jsp (170 words) |
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