Current Sexual Health Reports

, Volume 5, Issue 1, pp 43–50 | Cite as

Dyspareunia and vaginismus: Review of the literature and treatment

  • Alessandra GraziottinEmail author


Dyspareunia and vaginismus are sexual pain disorders that partially overlap and are neglected in clinical practice. The etiology of sexual pain disorders is multifactorial. Pain may be perceived at vaginal entry (introital dyspareunia) or deep in the pelvis (deep dyspareunia). It may be lifelong, acquired, generalized, or situational and cause personal and interpersonal distress. Dyspareunia has a solid biological etiology. Comorbidity is frequent with lower urinary tract symptoms, sex-associated and recurrent cystitis, vulvodynia, recurrent Candida infections, vaginal dryness, obstructive constipation, myalgia of the levator ani, endometriosis, and disorders of desire and arousal disorders. Vaginismus has a psychosexual etiology with a variable myogenic component. Dyspareunia and vaginismus affect the patient on many levels: sexual, medical, emotional, and relational. The aim of the paper is to share with physicians the key steps of a focused clinical history and physical examination for a comprehensive diagnosis and effective multimodal treatment of sexual pain disorders.


Irritable Bowel Syndrome Endometriosis Sexual Dysfunction Varicocele Interstitial Cystitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Graziottin A: Sexual pain disorders: dyspareunia and vaginismus. In Standard Practice in Sexual Medicine. Edited by Porst H, Buvat J. Oxford: Blackwell; 2006:342–350.CrossRefGoogle Scholar
  2. 2.
    Graziottin A: Treatment of sexual dysfunction. In Evidence Based Physiotherapy For The Pelvic Floor—Bridging Research and Clinical Practice. Edited by Bo K, Berghmans B, van Kampen M, Morkved S. Oxford: Elsevier; 2007:277–287.Google Scholar
  3. 3.
    Engman M, Wijma K, Wijma B: Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis. J Sex Marital Ther 2007, 33:171–186.PubMedCrossRefGoogle Scholar
  4. 4.
    Whitmore K, Siegel JF, Kellogg-Spadt S: Interstitial cystitis/painful bladder syndrome as a cause of sexual pain in women: a diagnosis to consider. J Sex Med 2007, 4:720–727.PubMedCrossRefGoogle Scholar
  5. 5.
    Pukall C, Lahaie M, Binik Y: Sexual pain disorders: etiologic factors. In Women’s Sexual Function and Dysfunction: Study, Diagnosis, and Treatment. Edited by Goldstein I, Meston CM, Davis S, Traish A. London: Taylor and Francis; 2005:236–244.Google Scholar
  6. 6.
    Ter Kuile MM, Van Lankveld JJ, Vlieland CV, et al.: Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus? J Psychosom Obstet Gynaecol 2005, 26:245–249.PubMedCrossRefGoogle Scholar
  7. 7.
    Graziottin A, Rovei V: Sexual pain disorders. In Sexual Health. Edited by Owens AF, Tepper MS. Westport, CT: Praeger; 2007:287–313.Google Scholar
  8. 8.
    Rosenbaum TY: Physiotherapy treatment in sexual pain disorders J Sex Marital Ther 2005, 31:329–340.PubMedCrossRefGoogle Scholar
  9. 9.
    Payne KA, Binik YM, Amsel R, Khalife S: When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain 2005, 9:427–436.PubMedCrossRefGoogle Scholar
  10. 10.
    Abramov L, Wolman I, David M: Vaginismus: an important factor in the evaluation and management of vulvar vestibulitis syndrome. Gynecol Obstet Invest 1994, 38:194–197.PubMedCrossRefGoogle Scholar
  11. 11.
    Basson R, Leiblum S, Brotto L, et al.: Revised definitions of women’s sexual dysfunction. J Sex Med 2004, 1:40–48.PubMedCrossRefGoogle Scholar
  12. 12.
    Wijma B, Engman M, Wijma K: A model for critical review of the literature—with vaginismus as an example. J Psychosom Obstet Gynaecol 2007, 28:21–36.PubMedCrossRefGoogle Scholar
  13. 13.
    Meana M, Binik YM, Khalife S, Cohen D: Dyspareunia: sexual dysfunction or pain syndrome? J Nerv Ment Dis 1997, 185:561–569.PubMedCrossRefGoogle Scholar
  14. 14.
    Reissing E, Binik Y, Khalifé S: Does vaginismus exist? A critical review of the literature. J Nerv Ment Dis 1999, 187:261–274.PubMedCrossRefGoogle Scholar
  15. 15.
    Binik Y: Should dyspareunia be classified as a sexual dysfunction in DSM-V? A painful classification decision. Arch Sex Behav 2005, 34:11–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Leiblum S: Vaginismus: a most perplexing problem. In Principles and Practice of Sex Therapy, edn 3. Edited by Leiblum SR, Rosen RC. New York: Guilford Press; 2000:181–204.Google Scholar
  17. 17.
    Lamont J: Vaginismus. Am J Obstet Gynecol 1978, 131:632–636.Google Scholar
  18. 18.
    van der Velde J, Laan E, Everaerd W: Vaginismus, a component of a general defensive reaction: an investigation of pelvic floor muscle activity during exposure to emotion inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12:328–331.PubMedCrossRefGoogle Scholar
  19. 19.
    Reissing E, Binik Y, Khalifé S: Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther 2003, 29:47–59.PubMedCrossRefGoogle Scholar
  20. 20.
    Vincenti E, Graziottin A: Sexual pain disorders: management by anesthetic blocks. In Women’s Sexual Function and Dysfunction: Study, Diagnosis, and Treatment. Edited by Goldstein I, Meston CM, Davis S, Traish A. London: Taylor and Francis; 2005:524–525.Google Scholar
  21. 21.
    Foster D: Chronic vulval pain. In Pain in Obstetrics and Gynecology. Edited by MacLean AB, Stones RW, Thornton S. London: RCOG Press; 2001:198–208.Google Scholar
  22. 22.
    Graziottin A, Brotto LA: Vulvar vestibulitis syndrome: a clinical approach. J Sex Marital Ther 2004, 30:125–139.PubMedCrossRefGoogle Scholar
  23. 23.
    Peters KM, Killinger KA, Carrico DJ, et al.: Sexual function and sexual distress in women with interstitial cystitis: a case control study. Urology 2007, 70:543–547.PubMedCrossRefGoogle Scholar
  24. 24.
    Graziottin A: Sexual pain disorders in adolescents. In Proceedings of the 12th World Congress of Human Reproduction, International Academy of Human Reproduction. Rome: CIC Edizioni Internazionali; 2005:434–449.Google Scholar
  25. 25.
    Graziottin A: Dyspareunia: clinical approach in the perimenopause. In The Management of Menopause, edn 3. Edited by Studd J. London: The Parthenon Publishing Group; 2003:229–241.Google Scholar
  26. 26.
    Graziottin A: Sexuality in postmenopause and senium. In Current Management of Menopause. Edited by Lauritzen C and Studd J. London: Martin Duniz; 2004:185–203.Google Scholar
  27. 27.
    Graziottin A, Bottanelli M, Bertolasi L: Vaginismus: a clinical and neurophysiological study. Urodynamica 2003, 14:117–121.Google Scholar
  28. 28.
    Harlow B, Wise L, Stewart E: Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001, 185:545–550.PubMedCrossRefGoogle Scholar
  29. 29.
    Harlow B, Stewart B: A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003, 58:82–88.PubMedGoogle Scholar
  30. 30.
    Alvarez D, Rockwell P: Trigger points: diagnosis and management. Am Fam Physician 2002, 65:653–660.PubMedGoogle Scholar
  31. 31.
    Wesselmann U, Burnett AL, Heinberg LJ: The urogenital and rectal pain syndromes. Pain 1997, 73:269–294.PubMedCrossRefGoogle Scholar
  32. 32.
    Oskai U, Baj N, Yalcin O: A study on urogenital complaints of postmenopausal women aged 50 and over. Acta Obstet Gynecol Scand 2005, 84:72–78.CrossRefGoogle Scholar
  33. 33.
    Friedrich E: Vulvar vestibulitis syndrome. J Reprod Med 1987, 32:110–114.PubMedGoogle Scholar
  34. 34.
    Bohm-Starke N, Hilliges M, Falconer C: Neurochemical characterization of the vestibular nerves in women with vulvar vestibulitis syndrome. Gynecol Obstet Invest 1999, 48:270–275.PubMedCrossRefGoogle Scholar
  35. 35.
    Bohm-Starke N, Hilliges M, Blomgren B: Increased blood flow and erythema in posterior vestibular mucosa in vulvar vestibulitis. Am J Obstet Gynecol 2001, 98:1067–1074.CrossRefGoogle Scholar
  36. 36.
    Bornstein J, Goldschmid N, Sabo E: Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecol Obstet Invest 2004, 58:171–178.PubMedCrossRefGoogle Scholar
  37. 37.
    Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999, 281:537–544.PubMedCrossRefGoogle Scholar
  38. 38.
    Bonica J: Definitions and taxonomy of pain. In The Management of Pain. Philadelphia: Lea & Febiger; 1990:35–87.Google Scholar
  39. 39.
    Woolf C: The pathophysiology of peripheral neuropathic pain: abnormal peripheral input and abnormal central processing. Acta Neurochir 1993, 58(Suppl):125–130.Google Scholar
  40. 40.
    Latthe P, Mignini L, Gray R, et al.: Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006, 332:749–755.PubMedCrossRefGoogle Scholar
  41. 41.
    Bachmann G, Rosen R, Pinn V, et al.: Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management J Reprod Med 2006, 51:447–456.PubMedGoogle Scholar
  42. 42.
    Bergeron S, Binik YM, Khalife S, et al.: A randomized comparison of group cognitive-behavioural therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001, 91:297–306.PubMedCrossRefGoogle Scholar
  43. 43.
    McKay E, Kaufman R, Doctor U, et al.: Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med 2001, 46:337–342.PubMedGoogle Scholar
  44. 44.
    Glazener C: Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol 1997, 104:330–335.PubMedGoogle Scholar
  45. 45.
    Ferrero S, Esposito F, Abbamonte L: Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril 2005, 83:573–579.PubMedCrossRefGoogle Scholar
  46. 46.
    Plaut M, Graziottin A, Heaton J: Sexual Dysfunction. Oxford: Health Press; 2004.Google Scholar
  47. 47.
    Mariani L: Vulvar vestibulitis syndrome: an overview of non-surgical treatment. Eur J Obstet Gynecol Reprod Biol 2002, 101:109–112.PubMedCrossRefGoogle Scholar
  48. 48.
    Pukall CF, Binik YM, Khalife S, et al.: Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain 2002, 96:163–175.PubMedCrossRefGoogle Scholar
  49. 49.
    Nappi RE, Ferdeghini F, Abbiati I, et al.: Electrical stimulation (ES) in the management of sexual pain disorders. J Sex Marital Ther 2003, 29(Suppl 1):103–110.PubMedCrossRefGoogle Scholar
  50. 50.
    North American Menopause Society: The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause 2007, 14:355–369.CrossRefGoogle Scholar
  51. 51.
    Crowley T, Richardson D, Goldmeier D; BASHH Special Interest Group for Sexual Dysfunction: Recommendations for the management of vaginismus: BASHH Special Interest Group for Sexual Dysfunction. Int J STD AIDS 2006, 17:14–18.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Center of Gynecology and Medical SexologyH. San Raffaele ResnatiMilanoItaly

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