Iron Deficiency as an Underrecognized Cause of Dyspareunia and Vulvar Bleeding

Iron deficiency is a common cause of anemia and is associated with a range of systemic effects. However, its direct impact on vulvovaginal tissue remains poorly described in the literature. We report the case of a 39-year-old woman with a history of gastric bypass surgery who presented with a 2-year history of severe dyspareunia and vulvar and vaginal mucosal tearing, including bleeding with minimal trauma, such as wiping after urination. The patient was seen by Gynecology for these symptoms, and a vulvar biopsy was suggested. Simultaneously, the patient was being treated for iron deficiency anemia by her primary care provider. Following intravenous iron replacement, the patient experienced significant resolution of dyspareunia and vulvar bleeding. This case suggests a potential association between iron deficiency and vulvovaginal mucosal atrophy or fragility. While iron deficiency is known to affect other mucosal tissues, its role in gynecologic symptoms, such as dyspareunia, has not been widely explored.