Persistent or recurrent pain experienced before, during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it disproportionately affects women. The symptom is reported almost exclusively by women, although the problem can also occur in men. Women with dyspareunia experience varying degrees of pain and discomfort in the vagina, clitoris or labia during intercourse. Dyspareunia can be triggered by numerous physical and psychological causes, many of which are treatable. Despite the fact that it is rarely discussed in polite circles, dyspareunia is a common condition that affects up to one-fifth of women at some point in their lives.

A medical evaluation of dyspareunia focuses initially on physical causes, which must be ruled out before psychogenic or emotional causes are entertained. In the majority of instances of dyspareunia, there is an original physical cause. Vaginal pain may be associated with a range of physical factors, including: insufficient lubrication; injury, trauma or irritation; inflammation, infection or skin disorder; and side effects to birth control products; vaginusmus (involuntary spasms of the muscles of the vaginal wall); and vestibulitis (unexplained stinging or burning around the opening of your vagina).

Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. Thus, 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. Often, poor self-esteem and body image are implicated, and the dyspareunic patient often has a history of overt or subtle sexual abuse. In these cases, individual and couples counseling are indicated.

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