Introduction To date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD). Aim To evaluate the prevalence of GPPPD and its associated factors. Methods This was a population-based, cross-sectional study of 590 healthy married women age 18–70 years conducted between May and October 2017 in Tehran, Iran. Main Outcome Measures Research tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik’s guideline for the diagnosis of GPPPD. Results 196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik’s guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik’s guideline was lowered to also include those reporting “somewhat” pain in addition to the group reporting “moderate” and “quite a bit or always,” then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD. Clinical Implications Reliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians’ judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain. Strengths & Limitations The present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik’s guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias. Conclusion Further research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures.

Background Recently known as the genito-pelvic pain/penetration disorder (GPPPD), Dyspareunia is considered a negative factor affecting a couple’s sexual health. This paper analyzes pain in Dyspareunia cases and determines protective factors causing lower levels of sexual distress among patients. Methods In a population-based cross-sectional study conducted in 2017, the cluster quota sampling technique was adopted to randomly select 590 Iranian married women aged 18–70 years from 30 health centers. The research tools included demographic data, a sexual distress scale, and Binik’s GPPPD questionnaire. Results In this study, the prevalence of self-report Dyspareunia, confirmed moderate Dyspareunia, and confirmed severe Dyspareunia (based on Binik’s proposed criteria) were 33 %, 25.8 %, and 10.5 %, respectively. Interestingly, 32 (34 %) out of 94 women who experienced severe pain based on Binik’s criteria reported no sexual distress. Compared to women with distress, they also had more positive body images, higher self-confidence, higher levels of sexual satisfaction, and more intimacy in their relationships (P = 0.000). In contrast, 8.5 % of the participants reported significant sexual distress even without confirmed Dyspareunia. Conclusions Improving intrapersonal characteristics such as self-confidence and body image as well as interpersonal factors such as sexual satisfaction and intimacy with a spouse can effectively treat Dyspareunia by alleviating sexual distress. The partner’s role in female pain and distress management would be more critical than previously thought.

Background: Dyspareunia (recently been named as GPPPD), is considered as one of the negative factors affecting couple’s sexual health. The present paper explores the characteristics of pain in dyspareunia cases and also determine protective factors cause fewer sexual distress among sufferers. Methods: A population-based cross-sectional study conducted in 2017, on 590 married women aging 18 -70 years, in 30 health center via cluster-quota sampling method. Demographic data, sexual distress and Binik’s GPPPD Questionnaire were utilized as study tools. Results: Although 33% of the women report dyspareunia, based on standard criteria the prevalence of severe and moderate dyspareunia were dropped to 10.5% and 25.8%, respectively that among them the most common location, time and type of pain were in vaginal entrance, at the beginning of intercourse and with burning nature, respectively. Dyspareunia had a significant negative impact not only on women’s ability to have intercourse (P=.004) but also on their sexual desire (P=.038). Interestingly, 5.4% of the women did not report any distress despite having severe dyspareunia. In comparison with those patients with distress, the latter group had higher sexual satisfaction, more positive body image and self-confidence, as well as more intimacy in relationship (P=.000). Notably, 19% of the participants experienced significant sexual distress, although in 8.5% of them dyspareunia was not confirmed. Conclusion: Promote personal characteristics such as positive self-confidence and body image and interpersonal factors like sexual satisfaction and intimacy, can be effective in the management of dyspareunia via decrease sexual distress.