Dyspareunia As a Clinical Problem


Г. С. Кочарян


The article contains definitions of dyspareunia, data about its incidence and place in the International Classification of Diseases, 10th Revision (code F.52.6 – Nonorganic dyspareunia, code N94.1 – Dyspareunia, which deals with a disorder of the organic origin) and 11th Revision (code GA12 – Dyspareunia, diagnosed in both the psychogenic nature of the disorder and its organic genesis) as well as in the last national American classification of sexual disorders reflected in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. The above classification uses the term «genito-pelvic pain/penetration disorder», code 302.76. In this case it means an integral diagnosis, which combines vaginismus and dyspareunia. The solution about advisability of using such a generalized diagnosis was taken in this classification with reference to the fact that the both sexual dysfunctions are highly comorbid and hardly differentiated.

Also the classifications of dyspareunia, which were and are used by clinical sexologists in the Soviet and post-Soviet space, are presented. It is emphasized that dyspareunia can be mixed. In such cases their appearance and development may occur with participation of sociogenic, psychogenic and biogenic factors, described in this article.

Also the article presents clinical manifestations of dyspareunia, information about its diagnosing as well as recommendations on treatment of genital pains using methods of psychotherapy (cognitive and cognitive-behavioral impacts, hypnosuggestive therapy, neuro-linguistic programming as well as couple, family and group therapy) and biological therapy (hormones, anti-inflammatory medicines, botulinum [type A], tranquilizers, antidepressants, anticonvulsants, physiotherapy and surgical treatment).


How to Cite
Кочарян, Г. С. (2020). Dyspareunia As a Clinical Problem. Health of Man, (3), 65–74. https://doi.org/10.30841/2307-5090.3.2020.216073
Sexology and andrology
Author Biography

Г. С. Кочарян, Kharkiv Medical Academy of Postgraduate Education

Garnik S. Kocharyan,

Department of Sexology and Medical Psychology


Диспареуния. – URL: https://ncagp.ru/index.php?_t8=301 (дата обращения: 19.07.2020).

Кочарян Г.С. Глава 3. Разъяснительная и рациональная психотерапия / Г.С. Кочарян, А.С. Кочарян. Психотерапия сексуальных расстройств и супружеских конфликтов. – М.: Медицина, 1994. – С. 23–39.

Кочарян Г.С. НЛП: терапевтические техники. 2-е изд., испр. и доп. – М.: Эксмо, 2009. – 176 с.

Кочарян Г.С. Приемы рациональной психотерапии в сексологической практике // Социально-психологические и медицинские аспекты брака и семьи: Тез. докл. 3-й обл. науч.-практ. конф. сексопатологов. – Харьков, 1987. – С. 422–423.

Кочарян Г.С. Современная сексология. – К.: Ника-Центр, 2007. – 400 с.

Крукс Р., Баур К. (Kruks R., Baur K.) Сексуальность / Пер. с англ. – СПб.: Прайм–ЕВРОЗНАК, 2005. – 480 с.

Мастерc У., Джонсон В., Колодни Р. (Masters W., Johnson V., Kolodny R.) Основы сексологии / Пер. с англ. – М.: Мир, 1998. – х. + 692 с.

Международная классификация болезней (10-й пересмотр). Классификация психических и поведенческих расстройств. Клинические описания и указания по диагностике. – СПб.: «АДИС», 1994. – 304 с.

Оразов М.Р., Носенко Е.Н., Покуль Л.В., Шкрели И., Токаева Э.С., Барсегян Л.К., Закирова Я.Р., Новгинов Д.С. Сексуальная функция женщин с эндометриозом. «Когда любовь причиняет боль»: систематический обзор влияния хирургического и медикаментозных методов лечения эндометриоза на сексуальную функцию женщин // Акушерство и гинекология: новости, мнения, обучение. – 2017. – № 3 – С. 133–143.

Свядощ А.М. Женская сексопатология. Издание пятое, перераб. и допол. – Кишинев: Штиинца, 1991. – 184 с.

Федорова А.И. Диспарейния: патогенез, диагностика, лечение : диссертация ... доктора психологических наук : 19.00.04 / Федорова Анна Игоревна; [Место защиты: ГУ «Санкт-Петербургский научно-исследовательский психоневрологический институт»]. – Санкт-Петербург, 2007. – 451 с.

Федорова А.И. Диспарейния: патогенез, диагностика, лечение. Автореф. диссертации ... доктора психологических наук. – Санкт-Петербург, 2007. – 50 с.

Хейм Лори Дж. (Heim Lori J.) Диспареуния: оценка каждого случая и дифференциальная диагностика // Международный медицинский журнал. – 2002, № 3. – URL: https://medi.ru/info/5668/ (дата обращения: 18.07.2020).

American College of Obstetrics and Gynecology. Chronic pelvic pain // Technical bulletin. – No. 223. – Washington, D.C.: ACOG, 1996.

Bain J.A. Thought control in everyday life. – New York, 1966.

Barbara G., Facchin F., Meschia M., Berlanda N., Frattaruolo M.P., VercellinI P. When love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning // Acta Obstet Gynecol Scand. – 2017. – 96 (6). – P. 668–687. DOI: 10.1111/aogs.13031.

Beard R.W., Reginald P.W., Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion // Br J Obstet Gynaecol. – 1988. – 95 (2). – P. 153–161. DOI: 10.1111/j.1471-0528.1988.tb06845.x.

Ben-David B., Friedman M. Gabapentin therapy for vulvodynia // Anesth Anal. – 1999. – 89 (6). – P. 1459–1460. DOI: 10.1097/00000539-199912000-00026.

Bomstein J., Shapiro S., Rahat M., Goldshmid N., Goldik Z., Abramovici H., et al. Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome // Am J Obstet Gynecol. – 1996. – 175 (1). – P. 139–144. DOI: 10.1016/s0002-9378(96)70263-6.

Crowley T., Richardson D., Goldmeier D. Recommendations for the management of vaginismus: BASHH Special Interest Group for Sexual Dysfunction // Int J STD AIDS. – 2006. – 17 (1). – P. 14–18. DOI: 10.1258/095646206775220586.

DeWitt D. E. Dyspareunia; Tracing the cause // Postgrad Med. – 1991. – 89 (5). – P. 67–68,70,73. DOI:10.1080/00325481.1991.11700891.

Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. – United States: American Psychiatric Association, 2013. – 947 p.

Engman M., Wijma K., Wijma B. Longterm coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus // Cogn Behav Ther. – 2010. – 39 (3). – P. 193–202. DOI: 10.1080/16506070903571014.

Fisher Kimberly A. Management of Dyspareunia and Associated Levator Ani Muscle Overactivity // Physical Therapy. – 2007. – 87 (7). – P. 935–941. DOI: 10.2522/ptj.20060168

Glatt A., Zinner S., McCormack W. The Prevalence of Dyspareunia // Obstetrics & Gynecology. – 1990. – 75 (3 Pt 1). – P. 433–436.

Goldstein A.T., Pukall C.F., Brown C., Bergeron S., Stein A., Kellogg-Spadt S.J. Vulvodynia: assessment and treatment // Sex Med. – 2016. – 13 (4). – P. 572–590. DOI: 10.1016/j.jsxm.2016.01.020

Haefner H.K., Collins M.E., Davis G.D., Haefner H.K., Collins M.E., Davis G.D., Edwards Libby, Foster David C., Hartmann Elizabeth Dee Heaton, Kaufman Raymond H., Lynch Peter J., Margesson Lynette J., Moyal-Barracco Micheline., Piper Claudia K., Reed Barbara D., Stewart Elizabeth G., Wilkinson Edward J. The vulvodynia guideline. // J Low Genit Tract Dis. – 2005. – 9 (1). – P. 40–51. DOI: 10.1097/00128360-200501000-00009.

Heim Lori J. Evaluation and Differential Diagnosis of Dyspareunia // Am Fam Physician. – 2001. – 63 (8). – P. 1535–1544.

ICD-11. – URL: https://en.wikipedia.org/wiki/ICD-11 (the date of the reference: 01.08.2020).

Jeremias J., Ledger W.J., Witkin S.S. Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis // Am J Obstet Gynecol. – 2000. – 182 (2). – P. 283–285. DOI: 10.1016/s0002-9378(00)70212-2.

Kliethermes C.J., Shah M., Hoffstetter S., Gavard J.A., Steele A.J. Effect of vestibulectomy for intractable vulvodynia // Minim Invasive Gynecol. – 2016. – 23 (7). – 1152–1157. DOI: 10.1016/j.jmig.2016.08.822

Kocharya G.S. (Кочарян Г.С.) Cognitive techniques in the treatment of patients with sexual dysfunction // Health of Man. – 2015. – No 4 (55). – P. 66–69. DOI: https://doi.org/10.30841/2307-5090.4(55).2015.104688

McKay M. Dysesthetic («essential») vulvodynia. Treatment with amitriptyline // J Reprod Med. – 1993. – 38 (1). – P. 9–13.

Mitchell K.R., Geary R., Graham C.A., Datta J., Wellings K., Sonnenberg P., Field N., Nunns D., Bancroft J., Jones K.G., Johnson A.M., Mercer C.H. Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey // BJOG. – 2017. – 124 (11). – P. 1689–1697. DOI: 10.1111/1471-0528.14518

Painful intercourse (dyspareunia). – URL: https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973#:~:text=Often%2C%20this%20can%20be%20treated,have% 20problems%20with%20vaginal%20lubrication. (the data of the reference: 08.07.2020).

Park A.J., Paraiso M.F. Successful use of botulinum toxin type A in the treatment of refractory postoperative dyspareunia // Obstet Gynecol. – 2009. – 114 (2 Pt 2). – P. 484–487. DOI: 10.1097/AOG.0b013e3181998ce1.

Pelletier F., Girardin M., Humbert P., Puyraveau M., Aubin F., Parratte B.J. Longterm assessment of effectiveness and quality of life of Onabotulinumtoxin A injections in provoked vestibulodynia // Eur Acad Dermatol Venereol. – 2016. – 30 (1). – P. 106–111. DOI: 10.1111/JDV.13437.

Reed Geoffrey M., Drescher Jack, Krueger Richard B., Atalla Elham, Cochran Susan D., First Michael B., Cohen-Kettenis Peggy T., Arango-de Montis Ivan, Parish Sharon J., Cottler Sara, Briken Peer, Saxena Shekhar. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations // World Psychiatry – 2016. – 15 (3). – P. 205–221. DOI: 10.1002/wps.20354

Rosenbaum T.Y. Physiotherapy treatment of sexual pain disorders // J Sex Marital Ther. – 2005. – 31 (4). – P. 329–340. DOI: 10.1080/00926230590950235.

Scheinfeld N. The role of gabapentin in treating diseases with cutaneous manifestations and pain // Int J Dermatol. – 2003. – 42 (6). – P. 491–495. DOI: 10.1046/j.1365-4362.2003.01831.x.

Seehusen Dean A., Baird Drew C., Darnall Carl R., Bode David V. Dyspareunia in Women // Am Fam Physician. – 2014. – 90 (7). – P. 465–470.

Soe L.H., Wurz G.T., Kao C.J., DeGregorio M.W. Ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy: potential benefits in bone and breast // Int J Womans Health. – 2013. – 5. – P. 605–611. DOI: 10.2147/IJWH.S39146.

Sorensen James, Bautista Katherine E., Lamvu Georgine, Feranec Jessica. Evaluation and Treatment of Female Sexual Pain: A Clinical Review // Cureus. – 2018. – 10 (3): e2379. DOI: 10.7759/cureus.2379

Steege J.F., Ling F.W. Dyspareunia: a special type of chronic pelvic pain // Obstet Gynecol Clin North Am. – 1993. – 20 (4). – P. 779–793.

Trahan Jennifer, Leger Erin, Allen Marlena, Koebele Rachel, Yoffe Mary Brian, Simon Corey, Alappattu Meryl, Figuers Carol. The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review // Journal of Women’s Health Physical Therapy. – 2019. – 43 (1). – P. 28–35. DOI: 10.1097/JWH.0000000000000117

Van Lankveld J.J., Weijenborg P.T., ter Kuile M.M. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners // Obstet Gynecol. – 1996. – 88 (1). – P. 65–70. DOI: 10.1016/0029-7844(96)00080-4.

Wasserman J. Pharmacological treatment of vulvodynia // National Vulvodynia Association News Letters. Spring, 2002.

What causes dyspareunia, or painful intercourse? Medically reviewed by University of Illinois. Written by Jayne Leonard on December 22, 2017. – URL: https://www.medicalnewstoday.com/articles/192590 (the date of the reference: 09.07.2020).

What You Need to Know About Dyspareunia (Painful Intercourse). Medically reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI. Written by Anna Zernone Giorgi. Updated on February 3, 2020. – URL: https://www.healthline.com/health/dyspareunia (the date of the reference: 09.07.2020).

Wolpe J. Psychotherapy by Reciprocal Inhibition. – Stanford University Press, 1958.