Dyspareunia

The complaint of dyspareunia is most typically regarded as a problem unique to women, and in fact, dyspareunia is relatively rare in men (Sandberg and Quevillon 1987). Bancroft (1989) indicated that only 1% of the men attending his Edinburgh clinic complained of dyspareunia, and Diokno et al. (1990) in the United States found that 1.4% of men 60 years or older reported pain during intercourse. In women, however, dyspareunia has been identified as the most common sexual complaint spontaneously reported to gynecologists (Steege 1984). Although incidence figures vary considerably depending on the age of respondents and the method and location of data collection, they range from 3% (Hawton 1982) to 34% (Glatt et al. 1990). Because dyspareunia is probably experienced more often than it is reported, incidence figures vary widely. Physicians and therapists who do not routinely question women about pain or discomfort during coitus generally report lower incidence figures than do those who consistently include such questions in the initial evaluation.

Patients typically seek sex therapy for dyspareunia only after seeking medical consultation and/or receiving unsuccessful medical treatment. In fact, the complaint of dyspareunia is often due to organic factors, although psychological factors typically exist as well. Not surprisingly, it is not always easy to determine whether psychological difficulties are the result or the cause of a sexual pain disorder.

Although dyspareunia is seen less frequently by mental health clinicians than by gynecologists, it is far from rare and is sometimes associated with a prior history of sexual or gynecological insult or trauma. Usually by the time the woman consults a specialist, marital problems accompany the sexual ones, and there may be a significant history of developmental and relational conflicts or difficulties.

According to DSM-IV (American Psychiatric Association 1994), the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus. Clinically, it is often difficult to separate dyspareunia from vaginismus, since vaginismus may occur secondary to a history of dyspareunia and even mild vaginismus is often accompanied by dyspareunia. It is important to establish whether the dyspareunia is acquired or lifelong and whether it is generalized (complete) or situational. Further inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment.