Dyspareunia

Abstract

Dyspareunia, better termed women's sexual pain, is a poorly understood disorder once believed to be purely psychologic. Thanks to cooperative research efforts from several specialties toward defining subsets of the disorder, understanding the etiology of subsets and their comorbidities and new concepts for diagnosis and management are being validated or are being put into practice. This review describes the surprising prevalence of sexual pain, outlines new definitions for subtypes of sexual pain and diagnostic criteria for them, and applies these diagnoses to the task of selecting treatment options.

Self-Reported Vulvar Pain Characteristics and Their Association with Clinically Confirmed Vestibulodynia

“…The WHO estimates that 8-22% of women suffer from dyspareunia. 9,10 Given that a large proportion of the incidence of dyspareunia can be attributable to known causes, the smaller proportion of these women will meet the ISSVD diagnostic criteria for vestibulodynia. Nevertheless, if, for example, a small proportion of women self-reporting no history of vulvar pain are truly misclassified as having vestibulodynia, our estimates of sensitivity could be substantially lower, though our specificity would not dramatically change.…”

Dyspareunia in Puerto Rican middle-aged women

“…Among the sexual dysfunctions described in females, dyspareunia appears to be common, with a prevalence of 7% in a national probability sample assessing sexual dysfunction in the United States 2. In a more recent meta-analysis of subtypes of chronic pelvic pain sponsored by the World Health Organization (WHO), the prevalence of dyspareunia varied from 1% in Sweden to 45% in the United States, and ranging from 8% to 21%, when high quality studies with representative samples were analyzed 7,8…”

“…Other studies classify dyspareunia into a pain syndrome resulting in sexual dysfunction 11–14. Dyspareunia can be subdivided into two groups, superficial/entry/introital dyspareunia and deep dyspareunia, with different etiologies and treatment options 8,11,15. The Report of the International Consensus Development Conference on Female Sexual Dysfunction evaluated and revised existing definitions and classifications of female sexual dysfunction.…”

“…Sexual pain is also characterized by vulvodynia, classified as any type of vulvar pain, and vulvar vestibulitis syndrome (VVS), a subcategory of vulvodynia and a diagnosis of exclusion 15. According to Friedrich, VVS is defined as severe pain with vestibular touch or attempted vaginal entry, tenderness to cotton swab pressure localized to the vulvar vestibule, and physical findings confined to various degrees of vestibular erythema 8. Vaginismus, classified in the DSM-IV as a sexual pain disorder is defined as recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted 10.…”

“…A number of factors have been consistently described in the literature to be associated with dyspareunia, including lower educational attainment, interpersonal relationships, depressive symptoms, menopause, low sexual desire, and pelvic floor disorders 2,8,11,13, 15–24. In addition, differences in ethnicity and cultural beliefs have been shown to influence the occurrence and reporting of sexual dysfunction 2,25.…”