Skip to main content

Advertisement

SpringerLink
Log in

Sexual pain in women: Etiology, management, and directions for future research

  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Sexual pain disorders are particularly prevalent in women. Because many causes of sexual pain exist, a variety of presentations and treatment options are available. Our understanding of these disorders is very limited, especially when no anatomic or behavioral explanations for the pain can be found. Sexual pain is a significant source of morbidity, and problems stemming from it may affect a woman’s sexual functioning, her psychological well-being, and her relationship with her partner. This paper discusses the basic mechanisms of pain sensation, the prevalence and causes of sexual pain in women, and the existing literature on the treatment of these conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Merskey H, Bogduk N: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, edn 2. Seattle: International Association for the Study of Pain; 1994.

    Google Scholar 

  2. Hainline B: Chronic pain: physiological, diagnostic, and management considerations. Psychiatr Clin North Am 2005, 28:713–735.

    Article  PubMed  Google Scholar 

  3. Graziottin A, Brotto LA: Vulvar vestibulitis syndrome: a clinical approach. J Sex Marital Ther 2004, 30:125–139 [Published erratum appears in J Sex Marital Ther 2004, 30:303.] This paper discusses a clinical algorithm for the evaluation and treatment of sexual pain.

    Article  PubMed  Google Scholar 

  4. Powell J, Wojnarowska F: Acupuncture for vulvodynia. J R Soc Med 1999, 92:579–581.

    PubMed  CAS  Google Scholar 

  5. Irving GA: Contemporary assessment and management of neuropathic pain. Neurology 2005, 64(12 Suppl 3):S21-S27. This paper provides a thorough discussion of neuropathic pain that is applicable to sexual and other pain disorders.

    PubMed  Google Scholar 

  6. Basson R, Berman J, Burnett A, et al.: Report of the international consensus development conference on female sexual dysfunction: Definitions and Classifications. J Urol 2000, 163:888–893.

    Article  PubMed  CAS  Google Scholar 

  7. Friedrich EG Jr: Vulvar vestibulitis syndrome. J Reprod Med 1987, 32:110–114.

    PubMed  Google Scholar 

  8. Mariani L: Vulvar vestibulitis syndrome: an overview of non-surgical treatment. Eur J Obstet Gynecol Reprod Biol 2002, 101:109–112.

    Article  PubMed  CAS  Google Scholar 

  9. Heim LJ: Evaluation and differential diagnosis of dyspareunia. Am Fam Physician 2001, 63:1535–1544.

    PubMed  CAS  Google Scholar 

  10. Basson R: Recent advances in women’s sexual function and dysfunction. Menopause 2004, 11:714–725.

    Article  PubMed  Google Scholar 

  11. Bergeron S, Binik YM, Khalife S, Pagidas K: Vulvar vestibulitis syndrome: a critical review. Clin J Pain 1997, 13:27–42.

    Article  PubMed  CAS  Google Scholar 

  12. Granot M, Lavee Y: Psychological factors associated with perception of experimental pain in vulvar vestibulitis syndrome. J Sex Marital Ther 2005, 31:285–302.

    Article  PubMed  Google Scholar 

  13. Reissing ED, Binik YM, Khalife S, et al.: Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther 2003, 29:47–59.

    PubMed  Google Scholar 

  14. Payne KA, Binik YM, Amsel R, Khalife S. When sex hurts, anxiety and fear orient patient attention towards pain. Eur J Pain 2004; 9:427–36.

    Article  PubMed  Google Scholar 

  15. Brauer M, Laan E, ter Kulie MM: Sexual arousal in women with superficial dyspareunia. Arch Sex Behav 2006, 35:191–200.

    Article  PubMed  Google Scholar 

  16. Lotery HE, Galask RP: Vulvodynia. Lancet 2004, 363:1058–1060.

    Article  PubMed  Google Scholar 

  17. Glazer HI: Dysesthetic vulvodynia. Long-term follow-up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation. J Reprod Med 2000, 45:798–802.

    PubMed  CAS  Google Scholar 

  18. Reissing ED, Binik YM, Khalife S, et al.: Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Arch Sex Behav 2004, 33:5–17.

    Article  PubMed  Google Scholar 

  19. Harlow BL, Stewart EG: A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003, 58:82–8.

    PubMed  Google Scholar 

  20. Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999, 281:537–544. [Published erratum appears in JAMA 1999, 281:1174.]

    Article  PubMed  CAS  Google Scholar 

  21. Buhling KJ, Schmidt S, Robinson JN, et al.: Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod 2006, 124:42–46.

    Article  Google Scholar 

  22. Laumann EO, Nicolosi A, Glasser DB, et al.: Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005, 17:39–57. This is an important survey on the prevalence of sexual dysfunctions throughout the world.

    Article  PubMed  CAS  Google Scholar 

  23. Lau JT, Kim JH, Tsui HY: Mental health and lifestyle correlates of sexual problems and sexual satisfaction in heterosexual Hong Kong Chinese population. Urol 2005, 66:1271–1281.

    Article  PubMed  Google Scholar 

  24. Bell, R: ABC of sexual health: homosexual men and women. BMJ 1999, 318:452–455.

    PubMed  CAS  Google Scholar 

  25. Lau JT, Kim JH, Tsui HY: Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study. Int J Impot Res 2006, 18:130–140.

    Article  PubMed  CAS  Google Scholar 

  26. Lamvu G, Robinson B, Zolnoun D, Steege JF: Vaginal apex resection: a treatment option for vaginal apex pain. Obstet Gynecol. 2004, 104:1340–1346.

    PubMed  Google Scholar 

  27. Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM: Hysterectomy and sexual functioning. JAMA 1999, 282:1934–1941.

    Article  PubMed  CAS  Google Scholar 

  28. Pinkerton JV, Shifren JL, La Valleur J, et al.: Influence of raloxifene on the efficacy of an estradiol-releasing ring for treating vaginal atrophy in postmenopausal women. Menopause 2003, 10:45–52.

    PubMed  Google Scholar 

  29. Ryan L, Hawton K: Female dyspareunia. BMJ 2004, 328:1357.

    Article  PubMed  Google Scholar 

  30. Perelman MA: Sex coaching for physicians: combination treatment for patient and partner. Int J Impot Res 2003, 15(Suppl 5):S67-S74.

    Article  PubMed  Google Scholar 

  31. Ferrero S, Esposito F, Abbamonte LH, et al.: Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril 2005, 83:573–579.

    Article  PubMed  Google Scholar 

  32. Aspera AM, Rackley RR, Vasavada SP: Contemporary evaluation and management of the female urethral diverticulum. Urol Clin North Am 2002, 29:617–624.

    Article  PubMed  Google Scholar 

  33. Brotto LA, Basson R, Gehring D: Psychological profiles among women with vulvar vestibulitis syndrome: a chart review. J Psychosom Obstet Gynaecol 2003, 24:195–203.

    Article  PubMed  CAS  Google Scholar 

  34. Seo JT, Choe JH, Lee WS, Kim KH: Efficacy of functional electrical stimulation-biofeedback with sexual cognitivebehavioral therapy as treatment of vaginismus. Urology 2005, 66:77–81.

    Article  PubMed  Google Scholar 

  35. Kabakci E, Batur S: Who benefits from cognitive behavioral therapy for vaginismus? J Sex Marital Ther 2003, 29:277–288.

    Article  PubMed  Google Scholar 

  36. Schnyder U, Schnyder-Luthi C, Ballinari P, Blaser A: Therapy for vaginismus: in vivo versus in vitro desensitization. Can J Psychiatry 1998, 43:941–4.

    PubMed  CAS  Google Scholar 

  37. Baram DA: Sexuality, sexual dysfunction, and sexual assault. In Novak’s Gynecology, edn 13. Edited by Berek JS. Baltimore: Lippincott, Williams, and Wilkins; 2002:295–321.

    Google Scholar 

  38. 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):103–10.

    PubMed  Google Scholar 

  39. Ghazizadeh S, Nikzad M: Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol 2004, 104:922–925.

    PubMed  CAS  Google Scholar 

  40. Goetsch MF: Simplified surgical revision of the vulvar vestibule for vulvar vestibulitis. Am J Obstet Gynecol 1996, 174:1701–1705; discussion 1705–1707.

    Article  PubMed  CAS  Google Scholar 

  41. Pagano R. Vulvar vestibulitis syndrome: an often unrecognized cause of dyspareunia. Aust N Z J Obstet Gynaecol 1999, 39:79–83.

    Article  PubMed  CAS  Google Scholar 

  42. Zolnoun DA, Hartmann KE, Steege JF: Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol 2003, 102:84–87.

    Article  PubMed  CAS  Google Scholar 

  43. Mann MS, Kaufman RH, Brown D Jr, Adam E: Vulvar vestibulitis: significant clinical variables and treatment outcome. Obstet Gynecol 1992, 79:122–125.

    PubMed  CAS  Google Scholar 

  44. Nyirjesy P, Sobel JD, Weitz MV, et al.: Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect 2001, 77:53–57.

    Article  PubMed  CAS  Google Scholar 

  45. Bergeron S, Brown C, Lord MJ, et al.: Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther 2002, 28:183–92.

    Article  PubMed  Google Scholar 

  46. Bergeron S, Binik YM, Khalife S, et al.: A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001, 91:297–306.

    Article  PubMed  CAS  Google Scholar 

  47. Dragisic KG, Milad MP: Sexual functioning and patient expectations of sexual functioning after hysterectomy. Am J Obstet Gynecol 2004, 190:1416–1418.

    Article  PubMed  Google Scholar 

  48. Zobbe V, Gimbel H, Andersen BM, et al.: Sexuality after total vs. subtotal hysterectomy. Acta Obstet Gynecol Scand 2004, 83:191–196.

    Article  PubMed  Google Scholar 

  49. Halperin R, Padoa A, Schneider D, et al.: Long-term followup (5-20 years) after uterine ventrosuspension for chronic pelvic pain and deep dyspareunia. Gynecol Obstet Invest 2003, 55:216–219.

    Article  PubMed  Google Scholar 

  50. Palomba S, Russo T, Falbo A, et al.: Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: A randomized study. Eur J Obstet Gynecol Reprod Biol 2006 Jan 24, Epub ahead of print.

  51. Ben-David B, Friedman M: Gabapentin therapy for vulvodynia. Anesth Analg 1999, 89:1459–1460.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Urology, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, 63110, St. Louis, MO, USA

    Alan W. Shindel MD

Authors
  1. Alan W. Shindel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathy K. Naughton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan W. Shindel MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shindel, A.W., Naughton, C.K. Sexual pain in women: Etiology, management, and directions for future research. Curr sex health rep 3, 169–174 (2006). https://doi.org/10.1007/s11930-006-0007-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-006-0007-5

Keywords

Search

Navigation