Dyspareunia, or painful sexual intercourse, is a common symptom among women.
Epidemiology
The prevalence of dyspareunia varies widely depending on the population being sampled and how it is defined. Systematic reviews report dyspareunia prevalence ranging from 8% to 35%.[1]Latthe P, Latthe M, Say L, et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006 Jul 6;6:177.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550236
http://www.ncbi.nlm.nih.gov/pubmed/16824213?tool=bestpractice.com
[2]Banaei M, Kariman N, Ozgoli G, et al. Prevalence of postpartum dyspareunia: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2021 Apr;153(1):14-24.
http://www.ncbi.nlm.nih.gov/pubmed/33300122?tool=bestpractice.com
One UK survey found that painful sex was reported by 7.5% of sexually active women.[3]Mitchell KR, Geary R, Graham CA, et al. Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG. 2017 Oct;124(11):1689-97.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638059
http://www.ncbi.nlm.nih.gov/pubmed/28120373?tool=bestpractice.com
In the US, dyspareunia is estimated to affect 10% to 20% of women.[4]Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537-44.
https://jamanetwork.com/journals/jama/fullarticle/188762
http://www.ncbi.nlm.nih.gov/pubmed/10022110?tool=bestpractice.com
[5]Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453-61.
http://www.ncbi.nlm.nih.gov/pubmed/27820938?tool=bestpractice.com
Classification
Dyspareunia and vaginismus have been grouped as genito-pelvic pain/penetration disorder in DSM-5-TR.[6]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. This is categorised as persistent or recurrent difficulty in vaginal penetration; marked pelvic or vulvovaginal pain during or while attempting penetration; fear or anxiety about pain before, during, or after penetration; and tightening or tensing of the pelvic floor muscles when penetration is attempted.[7]IsHak WW, Tobia G. DSM-5 changes in diagnostic criteria of sexual dysfunctions. Reprod Sys Sexual Disorders 2013;2:122. The DSM-5-TR criteria specify that symptoms must have been present for approximately 6 months, be causing the patient clinically significant distress, and not be better explained by a non-sexual mental disorder or a consequence of relationship distress or other significant stressors.[6]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Dyspareunia can be categorised as primary or secondary; as well as superficial or deep:[8]MacNeill C. Dyspareunia. Obstet Gynecol Clin N Am. 2006;33:565-577.
http://www.ncbi.nlm.nih.gov/pubmed/17116501?tool=bestpractice.com
Primary dyspareunia is characterised by pain associated with intercourse since the onset of sexual activity.
Secondary dyspareunia is acquired over a patient's sexual lifetime.
Painful intercourse that is localised to the introital area is characteristic of superficial dyspareunia, due to disorders of the vulva and vestibule.
Deep symptoms are often related to disorders in the pelvis.
