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Evaluation and Treatment of Dyspareunia

Steege, John F. MD; Zolnoun, Denniz A. MD, MPH

doi: 10.1097/AOG.0b013e3181a1ba2a
Clinical Expert Series
Expert Discussion

Dyspareunia affects 8–22% of women at some point during their lives, making it one of the most common pain problems in gynecologic practice. A mixture of anatomic, endocrine, pathologic, and emotional factors combine to challenge the diagnostic, therapeutic, and empathetic skills of the physician. New understandings of pain in general require new interpretations concerning the origins of pain during intercourse, but also provide new avenues of treatment. The outcomes of medical and surgical treatments for common gynecologic problems should routinely go beyond measures of coital possibility, to include assessment of coital comfort, pleasure, and facilitation of intimacy. This review will discuss aspects of dyspareunia, including anatomy and neurophysiology, sexual physiology, functional changes, pain in response to disease states, and pain after gynecologic surgical procedures.

In addition to a thorough history and physical examination, accurate diagnosis and successful treatment of dyspareunia often require attention to several different components. Supplemental Digital Content is available in the text

From the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

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Corresponding author: John F. Steege, MD, MPH, Department of Obstetrics and Gynecology, School of Medicine, Campus Box 7570, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.