Dyspareunia, or painful sexual intercourse, is a common symptom among women.
Summary
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] [2] One UK survey found that painful sex was reported by 7.5% of sexually active women.[3] In the US, dyspareunia is estimated to affect 10% to 20% of women.[4] [5]
Classification
Dyspareunia and vaginismus have been grouped as genito-pelvic pain/penetration disorder in DSM-5-TR.[6] 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] 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]
Dyspareunia can be categorized as primary or secondary; as well as superficial or deep:[8]
- 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.
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Bulging, bluish imperforate hymen with hematocolpos
Cervicitis and vaginal discharge due to gonorrhea
Cervicitis due to Herpes simplex virus; erosive inflammation with accompanying paracervical purulency is seen
Trichomonas vaginitis with copious purulent discharge emanating from the cervical os
Ultrasound of ovarian endometrioma
Laparoscopic image of ovarian endometrioma
Citations
IsHak WW, Tobia G. DSM-5 changes in diagnostic criteria of sexual dysfunctions. Reprod Sys Sexual Disorders 2013;2:122.
Lee NMW, Jakes AD, Lloyd J, et al. Dyspareunia. BMJ. 2018 Jun 19;361:k2341.[Abstract][Full Text]
National Institute for Health and Care Excellence. Endometriosis: diagnosis and management. Apr 2024 [internet publication].[Full Text]
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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.[Abstract][Full Text]
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