Dyspareunia Diagnosis

NewsGuard 100/100 Score

Dyspareunia is a commonly neglected condition that manifests with persistent or recurrent urogenital pain just before, during or following sexual intercourse, mostly due to physical or psychological causes. This disorder may be generalized, acquired and lifelong, causing substantial personal (and interpersonal) distress.

As both organic and psychosexual components may be responsible for dyspareunia, there is a need for a thorough patient assessment – including medical history, physical examination and psychological evaluation. Such multidisciplinary approach is warranted prior to any treatment interventions.

Medical History

When evaluating a patient with dyspareunia, thorough medical, surgical, reproductive, psychiatric, sexual and social information should be sought. This should be supplemented with prior medical and reproductive history, current health status, thyroid and endocrine system review, as well as psychiatric evaluation.

Since pain is considered subjective, it is most often measured by using patient’s self-reporting. Moreover, any assessment should encompass a precise description of the location, quality, intensity and duration of the pain, as well as the degree of interference with individual’s sexuality.

Also, drug usage history should be taken, as a myriad of prescribed medications (such as alpha-blockers, beta-blockers, steroids, antipsychotics, antidepressants and anticonvulsants) may have serious sexual side-effects. Hence, it is crucial to make a timeline of drug use and compare it with the timeline of sexual pain occurrence.

Physical Examination

Physical examination entails a mandatory visual inspection of both external and internal genital structures to determine potential etiology of pain. The mucosal surfaces have to be inspected in detail for areas of discoloration or redness, which may point to certain dermatological conditions or infections.

Forceful entry or deficient lubrication may present with abrasions or other types of trauma. The use of cotton swab is a way towards exact identification of the source of pain, as it may be used to collect discharge (when present) for further testing. Dry vaginal mucosa suggests atrophic changes or chronic vaginal dryness, while abnormal discharge may point towards an infectious source.

The internal examination procedure should generally be performed by using a single finger in order to maximize the comfort of the affected individual. Muscular tenderness or difficulties with voluntary contractions and relaxations suggest dysfunction of the pelvic floor muscle. The urethra, urinary bladder and cervix should be palpated to exclude potential causes of dyspareunia linked to these organs (e.g. endometriosis).

Such single-finger exams should be followed by a bimanual examination to evaluate structures found in the pelvis (of course, if this procedure is not too uncomfortable for the affected woman). A small speculum is used to visualize internal structures, while tests for sexually transmitted diseases are pursued if there is a discharge present, or a history of unprotected sexual intercourse.

Painful Sex (Dyspareunia & Vaginismus) - Lauren Streicher, MD

Psychological Evaluation

As dyspareunia may include both sensorial and affective aspects, there is a need for meticulous psychological evaluation. This often supplements physical examination and provides useful information about potential predisposing factors (such as familial influences, sexual experiences, and potential history of sexual abuse or trauma).

Moreover, difficulties that arise in a marriage or relationship should always be documented, even though it is often impossible to separate cause from consequence. The main reason is because a patient with dyspareunia often has significantly higher levels of mood disturbances and hypervigilance, as well as lower thresholds of pain tolerance and/or endurance.

Specific sexuality questionnaires that are an indispensable part of self-administered measures play a pivotal role in both the diagnosis and treatment of dyspareunia, primarily by providing specific indicators used to evaluate the treatment outcomes. These questionnaires often reflect characteristic behaviors which are prime targets of clinical interventions.


  1. http://www.bmj.com/content/328/7452/1357
  2. http://www.aafp.org/afp/2014/1001/p465.html
  3. http://www.aafp.org/afp/2001/0415/p1535.html
  4. https://www.ncbi.nlm.nih.gov/pubmed/19384129
  5. http://www.tjog-online.com/article/S1028-4559(11)00123-9/fulltext
  6. Dor K. Dyspareunia. In: O’Connell TX, Dor K. Instant Work-Ups: A Clinical Guide to Obstetric and Gynecologic Care. Elsevier Health Sciences, 2009; pp. 66-70.

Further Reading

Last Updated: Feb 26, 2019

Dr. Tomislav Meštrović

Written by

Dr. Tomislav Meštrović

Dr. Tomislav Meštrović is a medical doctor (MD) with a Ph.D. in biomedical and health sciences, specialist in the field of clinical microbiology, and an Assistant Professor at Croatia's youngest university - University North. In addition to his interest in clinical, research and lecturing activities, his immense passion for medical writing and scientific communication goes back to his student days. He enjoys contributing back to the community. In his spare time, Tomislav is a movie buff and an avid traveler.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Meštrović, Tomislav. (2019, February 26). Dyspareunia Diagnosis. News-Medical. Retrieved on May 28, 2024 from https://www.news-medical.net/health/Dyspareunia-Diagnosis.aspx.

  • MLA

    Meštrović, Tomislav. "Dyspareunia Diagnosis". News-Medical. 28 May 2024. <https://www.news-medical.net/health/Dyspareunia-Diagnosis.aspx>.

  • Chicago

    Meštrović, Tomislav. "Dyspareunia Diagnosis". News-Medical. https://www.news-medical.net/health/Dyspareunia-Diagnosis.aspx. (accessed May 28, 2024).

  • Harvard

    Meštrović, Tomislav. 2019. Dyspareunia Diagnosis. News-Medical, viewed 28 May 2024, https://www.news-medical.net/health/Dyspareunia-Diagnosis.aspx.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.