Dyspareunia

Painful sexual intercourse or pain provoked by activity involving insertion into the vagina is known as dyspareunia; this is a common female health problem and a complex disorder that is often overlooked. According to The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revised (DSM-5-TR; APA, 2022), dyspareunia is now combined with vaginismus into 1 of the 4 major categories of female sexual dysfunction, called genitopelvic pain-penetration disorder (GPPPD). The definition of GPPPD is marked pain during intercourse or vaginal penetration attempts,  tightening of the vaginal muscles with decreased ability to accommodate penetration, tension, pain, or burning felt when penetration is attempted, and a decrease or no desire to have intercourse, resulting in avoidance of sexual activity or intense phobia of pain. These symptoms must be present for 6 months and cause significant distress to the patient. According to the International Society for the Study of Women’s Sexual Health (ISSWSH), GPPPD encompasses not only pain or difficulty during penetration but also discomfort associated with any form of genital contact. This condition may involve increased tension or overactivity of the pelvic floor muscles, which can occur with or without direct genital stimulation. The prevalence of dyspareunia ranges from 3% to 18% worldwide and can affect 10% to 28% of the population over a lifetime. Dyspareunia can be further categorized into superficial or deep, and primary or secondary. Superficial dyspareunia is limited to the vulva or vaginal entrance, while deep dyspareunia involves pain in the deeper parts of the vagina or lower pelvis. Deep dyspareunia is frequently associated with endometriosis and deep sexual penetration. Primary dyspareunia is pain that initiates at the start of the patient having sexual intercourse, without a time of having pain-free vaginal penetration. Secondary dyspareunia is pain that begins after some time of pain-free sexual activity. Dyspareunia may occur with vulvodynia, a genital pain that lasts longer than 3 months with or without the association of sexual intercourse. Dyspareunia can also lead to sexual difficulties, such as a lack of sexual desire and arousal, and can cause trouble in sexual relationships. The condition can have a significant impact on physical as well as mental health and can lead to depression, anxiety, hypervigilance to pain, negative body image, and low self-esteem. Prompt management is therefore crucial when addressing this condition.