Evaluation of dyspareunia

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 categorized 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 nonsexual 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 categorized 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 characterized 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 localized 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.