Essentials of Female Sexual Dysfunction from a Sex Therapy Perspective

Linda E. Ohl, MSW, CSW, ACH


Urol Nurs. 2007;27(1):57-63. 

In This Article

Sexual Pain Disorders

Vaginismus is a recurrent, involuntary contraction of the perineal muscle surrounding the outer third of the vagina when vaginal penetration is attempted with a penis, finger, tampon, or speculum. Attempts at penetration cause great pain, and at times are impossible due to muscle tightening. Intercourse is impaired, and penetration may even be impossible. The muscular contractions can be painful alone, but this pain can be compounded by attempting to force penetration by the partner. To be considered significant, the disturbance must cause personal distress, and not be explained by external factors.

Rosen, Taylor, Leiblum, and Bachmann (1993) reported a 12% incidence of vaginismus occurring at least 50% of the time during attempts at sexual activity.

This condition is characterized by recurrent or persistent genital pain associated with sexual activity. It should cause distress, and must not be due exclusively to vaginismus, or lack of lubrication (which would be FSAD). It cannot be accounted for by another psychiatric condition or use of drugs or medications.

The entire vaginal area can be painful to touch. Dull, aching, or even sharp sensations are reported by many women when seeing their physician. Pain may be detected when penetration of a penis, tampon, finger, or another object is inserted into the vagina. Women may even feel discomfort when wearing tight pants or nylons.

There are many reasons for sexual pain including anatomic abnormalities. Post-surgical changes are a common reason for internal pain during intercourse. Allergic reaction to hygiene products can cause burning, itching, and swelling of the vaginal tissue. Discomfort may be due to bacterial or yeast infections. Lack of estrogen may cause thinning of the vaginal walls, leading to lack of lubrication, which can create burning and stinging when penetration is attempted.

The lifetime prevalence of sexual pain disorder ranges from 17% to 19% from population-based survey studies (Paik & Laumann, 2006). Interestingly, despite the fact that clinical studies report a similar lifetime incidence of 10% to 20%, when queried about current problems, women in clinic-based studies report a much higher incidence of problems (21%-48%) than population studies (3%-13%) (Paik & Laumann, 2006). It is interesting that "current" incidences are reported to be higher than lifetime incidences, leading one to suppose that women forget episodes of acute problems seen in a medical setting after a period of time.


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