ABSTRACT
Dyspareunia literally means “bad or difficult mating,” and it is manifest as persistent painful intercourse which can occur at any age, in both sexes. The pain can begin at penetration, during thrusting, at the time of orgasm or postcoital. Dyspareunia is characterized by location, onset, and frequency. Pain can be located at the vaginal entry, known as “introital,” “entry,” or “superficial” dyspareunia, or pain can occur after penetration localized at the cervix or lower abdominal area, known as “deep” dyspareunia. Introital dyspareunia is usually described as sharp burning or pinching and most commonly occurs with vulvar disorders and with vaginismus. Deep dyspareunia is often described as burning, fullness, or something being bumped, and is most often associated with abdominal, uterine, cervical, ovarian, and vaginal disorders. Primary dyspareunia is present if intercourse has always been accompanied by pain. Symptoms may be dated from initial tampon use or initiation of attempted vaginal insertion, associated with the use of a speculum on gynecological examination, or with initial digital or penile insertion. Primary dyspareunia is often associated with vulvar disorders, structural abnormalities, and psychosocial factors. Secondary dyspareunia onsets follow a period of painfree vaginal penetration and sexual functioning and are often associated with a specific event, such as an infection, or a condition, such as atrophic changes with menopause or endometriosis. Dyspareunia frequency may occur on all occasions of penetration, with all partners, positions, and situations, or be situational, occurring only with specific conditions such as size of object inserted, depth of insertion, a specific partner, or only when premenstrual.
