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Purpose: To provide a case study for the discussion, diagnosis, management, and comprehensive plan of care for primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia for the advanced practice registered nurse (APRN) working in primary care. Data sources: Selected text, research, clinical articles, and personal communication with expert APRNs. Conclusions: Three of the most commonly presenting women's health related conditions include primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia. These conditions can present a challenge in developing an accurate differential diagnosis and appropriate plan of care. This article presents the reader with a detailed case study that provides an analysis of each potential differential diagnosis with rationale. A recommended diagnostic and therapeutic plan of care is included for the reader's review. Implications for practice: If left untreated, primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia can result in pain, suffering, and impaired fertility and sexual function. Patients frequently experience symptoms for months to years prior to accurate diagnosis.

In two Norwegian industrial companies 234 women of menstruating age were examined by the industrial nurse with regard to menstrual complaints. Every second woman experienced pain, 23% had consulted a doctor previously, about 30% had to stay in bed, and about 30% had been absent from work recently due to dysmenorrhea. Although pain was prevalent in all age groups, there were age-specific differences in other complaints, such as headache and depression, which were more frequent among the older women. In a selected group of 32 women with severe complaints, the history and gynecological examination indicated secondary dysmenorrhea in only a few cases. Hormonal assays and endometrial biopsy indicated anovulatory cycles in 4 out of 12 women, in spite of dysmenorrhea.