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Approach to the woman with sexual pain

Elizabeth Gunther Stewart, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Sexual problems are highly prevalent in women. In the United States, approximately 40 percent of women have sexual concerns and 12 percent report distressing sexual problems [1]. Female sexual dysfunction takes different forms, including lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity [2].

Sexual pain disorders may be primary (ie, pain present at first intercourse) or secondary (ie, pain developing after previously pain-free intercourse), and may be complete (with each sexual experience) or situational (with some experiences or partners, but not others). The etiologic spectrum ranges from simple anatomic problems to complex psychosocial/biologic issues. The intricate interaction of anatomical, physiological, and psychological factors that contribute to painful intercourse explains the etymology of "dyspareunia," which means "bad or difficult mating." (See "Differential diagnosis of sexual pain in women".)

A general approach to women with sexual pain disorders will be reviewed here. Etiologies of sexual pain disorders and treatment are discussed separately. (See "Differential diagnosis of sexual pain in women" and "Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy)" and "Clinical manifestations and diagnosis of localized vulvar pain syndrome (formerly vulvodynia, vestibulodynia, vulvar vestibulitis, or focal vulvitis)" and "Treatment of myofascial pelvic pain syndrome in women".)


Anatomic and physiologic studies of the vaginal vestibule, vagina, bladder, and anus provide insight into possible neurologic pathways for transmission of genital pain in women who are otherwise healthy.

The vulvar vestibule, urethra, and bladder have a common embryologic origin, which may explain the concurrence of pain at two or more of these sites. As an example, interstitial cystitis is frequently accompanied by pain in the vestibule.


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Literature review current through: Sep 2016. | This topic last updated: Nov 18, 2014.
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