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.
Library
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. Nov 2024 [internet publication].[Full Text]
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.[Abstract][Full Text]
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.[Abstract]
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]
4. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537-44.[Abstract][Full Text]
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.[Abstract]
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
7. IsHak WW, Tobia G. DSM-5 changes in diagnostic criteria of sexual dysfunctions. Reprod Sys Sexual Disorders 2013;2:122.
8. MacNeill C. Dyspareunia. Obstet Gynecol Clin N Am. 2006;33:565-577.[Abstract]
9. Lee NMW, Jakes AD, Lloyd J, et al. Dyspareunia. BMJ. 2018 Jun 19;361:k2341.[Abstract][Full Text]
10. Bachmann GA, Leiblum SR, Grill J. Brief sexual inquiry in gynecology practice. Obstet Gynecol. 1989;73:425-427.[Abstract]
11. Cowan F, Frodsham L. Management of common disorders in psychosexual medicine. The Obstetrician & Gynaecologist. 2015 Jan;17(1):47-53
12. American College of Obstetricians and Gynecologists. Committee opinion no. 673: persistent vulvar pain. Sep 2016 [internet publication].[Full Text]
13. Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022 May;36(5):641-50.[Abstract][Full Text]
14. Centers for Disease Control and Prevention. Mycoplasma genitalium. Jul 2021 [internet publication].[Full Text]
15. Centers for Disease Control and Prevention. Genital herpes. Sep 2022 [internet publication].[Full Text]
16. Patel R, Green J, Clarke E, et al. 2014 UK national guideline for the management of anogenital herpes. Int J STD AIDS. 2015 Oct;26(11):763-76.[Abstract][Full Text]
17. National Institute for Health and Care Excellence. Endometriosis: diagnosis and management. Nov 2024 [internet publication].[Full Text]
18. American College of Radiology. ACR appropriateness criteria: clinically suspected adnexal mass, no acute symptoms. 2023 [internet publication].[Full Text]
19. American College of Radiology. ACR appropriateness criteria: fibroids. 2022 [internet publication].[Full Text]
20. Reid S, Leonardi M, Lu C, et al. The association between ultrasound-based 'soft markers' and endometriosis type/location: A prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2019 Mar;234:171-8.[Abstract]
21. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016 Sep;48(3):318-32.[Abstract][Full Text]
22. Okaro E, Condous G, Khalid A, et al. The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain--can we reduce the need for laparoscopy? BJOG. 2006 Mar;113(3):251-6.[Abstract]
23. Agostinho L, Cruz R, Osório F, et al. MRI for adenomyosis: a pictorial review. Insights Imaging. 2017 Dec;8(6):549-56.[Abstract][Full Text]
24. Lim RP, Lee VS, Bennett GL, et al. Imaging the female pelvis at 3.0 T. Top Magn Reson Imaging. 2006 Dec;17(6):427-43.[Abstract][Full Text]
25. Maciel C, Bharwani N, Kubik-Huch RA, et al. MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines. Eur Radiol. 2020 Aug;30(8):4272-83.[Abstract][Full Text]
26. Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14-22.[Abstract]
27. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]
28. Shah A, Panjabi C. Human seminal plasma allergy: a review of a rare phenomenon. Clin Exp Allergy. 2004;34:827-838.[Abstract]
29. Bernstein JA. Human seminal plasma hypersensitivity: an under-recognized women's health issue. Postgrad Med. 2011 Jan;123(1):120-5.[Abstract]
30. Sublett JW, Bernstein JA. Seminal plasma hypersensitivity reactions: an updated review. Mt Sinai J Med. 2011 Sep-Oct;78(5):803-9.[Abstract]
31. Bergeron S, Binik YM, Khalife S, et al. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol. 2001;98:45-51.[Abstract][Full Text]
32. Kelly KG. Tests on vaginal discharge. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston, MA: Butterworths; 1990.[Abstract][Full Text]
33. British Association for Sexual Health and HIV. 2018 United Kingdom national guideline for the management of pelvic inflammatory disease. 2018 [internet publication].[Full Text]
