Should Dyspareunia Be Retained as a Sexual Dysfunction in DSM-V? A Painful Classification Decision

Sexual Pain Disorders: Dyspareunia and Vaginismus

“…Normal trophism, both mucosal and cutaneous, adequate hormonal impregnation, lack of inflammation, particularly at the introitus, normal tonicity of the perivaginal muscles, vascular, connective and neurological integrity and normal immune response are all considered necessary to guarantee vaginal 'habitability' [6,7,[15][16][17]. Vaginal receptiveness may be further modulated by psychosexual, mental and interpersonal factors, all of which may result in poor arousal with vaginal dryness [5,7,[8][9][10][11].…”

“…Focusing on the intensity and characteristics of pain is a relatively new approach in addressing dyspareunia [5][6][7]16,17]. A shift from nociceptic to neuropathic pain is typical of chronic dyspareunia, and treatment may require a systemic and local analgesic approach [3,6].…”

“…• accurate physical examination, to describe: the 'pain map', i e any site in the vulva, introitus, midvagina and deep vagina where pain can be elicited [16,18,19,40]; pelvic floor trophism (and vaginal pH), muscular tonus, strength and performance and myogenic and referred pain [16,21]; signs of inflammation (primarily vulvar vestibulitis) [6,16,23]; poor outcome of pelvic [41] or perineal surgery (episiotomy/rraphy) [31]; associated urogenital and rectal pain syndromes [22]; neuropathic pain, in vulvodynia or localized clitoralgia with no objective findings [3,5,7]; • psychosexual factors, poor arousal and coexisting vaginismus [6,7,9,10,15,24];…”

Predictors of Genital Pain in Young Women

“…This omission is surprising in light of the 15-20% of the female population aged 18-29 who experience dyspareunia (Laumann, Paik, & Rosen, 1999;Mercer et al, 2003). Dyspareunia is defined as the experience of pain during sexual intercourse and/or nonsexual pain with vaginal penetration (Binik, 2005). The symptom of pain in dyspareunia may be caused by multiple disease states, including underlying infection, allergies, muscle tension, hormone deregulation, genital abnormalities, endometriosis or tissue damage following pelvic injury or surgery (Basson et al, 2004).…”

“…A second interpretation is that lubrication is the defining functional deficit that distinguishes between high and low genital pain. Lack of lubrication can be both a cause and a consequence of painful intercourse (Binik, 2005;Wiegel et al, 2005). In the future, it would be useful to assess differences in lubrication between vaginal penetration and solitary selfstimulation by means other than self-report so that baseline lubrication can be compared to levels achieved during intercourse (Van Lankveld et al, 1996).…”