Intended for healthcare professionals

Clinical Review ABC of sexual health

Female sexual problems II: sexual pain and sexual fears

BMJ 1999; 318 doi: (Published 09 January 1999) Cite this as: BMJ 1999;318:110
  1. Josie Butcher

    Dyspareunia and vaginismus are two common and extremely frustrating sexual dysfunctions for women. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists them as two separate disorders in the subcategory of sexual dysfunctions.

    Belief that her vagina is too small may be one of the reasons for a woman's fear of vaginal penetration. (Cinesias entreating Myrrhina to coition, 1896, by Aubrey Beardsley)


    Dyspareunia is recurrent genital pain associated with sexual activity and can be classified as primary, when pain has always occurred during sexual activity, or secondary, when it occurs after a period of pain free lovemaking. The term is usually used to describe pain on penetration, but it can occur during genital stimulation. It is best described according to the site of the pain.

    Traditionally, it was thought that superficial dyspareunia (at or around the vaginal entrance) is likely to have a psychogenic origin, whereas deep dyspareunia is likely to have an organic cause. These explanations are no longer considered helpful. It is important to try to identify the history of the pain, its site, sort, severity, onset, duration, and any other associated factors. Look for any physical abnormalities and discuss their effects on the sexual relationship. It must be remembered that physical signs are not always visible, and vulval histology is sometimes required. It is never enough to suggest that dyspareunia is simply psychological, and it should be looked at medically before any psychological components are considered.

    Cycle of sexual pain and avoidance of sexual activity

    Repeated sexual pain can set up a cycle of pain, in which fear of pain leads to avoidance of the sexual activity that produces it, in turn leading to lack of arousal, failure to achieve orgasm, and loss of sexual desire. This can progress to total avoidance of sexual activity and …

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