Definition of Dyspareunia
Dyspareunia is defined as recurrent or persistent pain with sexual intercourse that causes distress. 1 It is a common condition affecting approximately 10-20% of women in the United States.
Types of Dyspareunia
Dyspareunia can be categorized based on location:
- Superficial (Entry) Dyspareunia: Pain experienced at the vaginal entrance during attempted penetration 1
- Deep Dyspareunia: Pain felt deep in the pelvis during intercourse 1
Diagnostic Criteria
According to current medical guidelines, dyspareunia (now also referred to as genito-pelvic pain/penetration disorder or GPPPD) is characterized by at least one of the following symptoms persisting for at least 6 months 2:
- Marked vulvovaginal or pelvic pain during penetrative intercourse or penetration attempts
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of penetration
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
Common Causes
Superficial Dyspareunia
- Vulvodynia 3
- Inadequate lubrication 3
- Vaginal atrophy 3
- Vaginismus (involuntary spasm of vaginal muscles) 1
- Lichen sclerosus 3
Deep Dyspareunia
- Endometriosis 1
- Pelvic floor dysfunction 1
- Pelvic adhesions 4
- Adnexal pathology 4
- Uterine retroversion 1
- Pelvic congestion 4
Impact on Health and Quality of Life
Women experiencing dyspareunia are at increased risk for:
- Sexual dysfunction
- Relationship distress
- Diminished quality of life
- Anxiety and depression 1
The NCCN Survivorship Guidelines specifically recognize dyspareunia as a significant symptom that impacts quality of life and requires appropriate management 3. The ESO-ESMO guidelines also highlight that dyspareunia is often caused by vaginal dryness and can significantly impact sexual health in cancer survivors 3.
Assessment Approach
Modern approaches to dyspareunia favor an integrated pain model rather than purely psychological theories 4. Proper evaluation includes:
- Detailed pain characteristics (location, intensity, duration)
- Physical examination including:
- Visual inspection of external genitalia
- Sequential pressure with cotton swab to assess for focal erythema or pain
- Single-digit vaginal examination to identify tender pelvic floor muscles
- Bimanual examination to assess for uterine retroversion and pelvic masses 1
Clinical Significance
Understanding dyspareunia is essential as it represents a significant health concern that affects not only physical but also psychological well-being. The prevalence of dyspareunia varies across populations, with postpartum studies showing rates of 35% overall, with 43% experiencing it from 2-6 months postpartum and 22% from 6-12 months postpartum 3.
Recognizing dyspareunia early and addressing its underlying causes can significantly improve quality of life and prevent the development of associated psychological distress and relationship difficulties.