Psychological Causes of Dyspareunia

In virtually all cases of dyspareunia, psychological factors are implicated either directly (as the cause) or indirectly (as a concomitant of the sexual discomfort). Psychological assessment must include a complete developmental history, with particular attention to the sexual values and messages of the client's immediate family and their religious persuasion and beliefs, as well as a careful psychosexual history. It is not uncommon to find that sexuality is associated with sin and immorality and that feelings of guilt and fear accompanied early sexual exploration and experimentation. Often, poor self-esteem and body image are implicated, and the dyspareunic patient may have a history of overt or subtle sexual abuse (Walker et al. 1988).

Case Example

Ms. E, a 28-year-old married woman, was referred to the sex therapy clinic after having consulted 11 gynecologists in 10 years complaining of disabling and distressing dyspareunia. Although various diagnoses were made, ranging from chronic yeast infections to endometriosis, no definitive reason for her sexual complaints could be established, and all physical treatments proved ineffective.

Ms. E acknowledged that sex had always been a source of conflict for her, both because of her negative feelings about the female genitalia and because of her negative associations about sex generally. "Sex is like Alaska," she said. "It's cold, dark, barren."