According to the 2002 Polish Sexuality Report, as many as 13% of women and 2% of men surveyed suffer from pain during sexual intercourse, i.e. dyspareunia. An additional 2% of women suffer from vaginismus, i.e. an involuntary tightening of the vaginal muscles that prevents penetration. This demonstrates the magnitude of the problem, yet few potential patients seek professional help for this condition, and there is also a feeling of low competence among professionals in dealing with patients' sexual problems. This text is dedicated to the symptoms and treatment of dyspareunia.
Symptoms of dyspareunia
According to the ICD-10 classification in force in Europe, and therefore also in Poland, sexual dysfunctions are diagnosed if they last for at least six months. This means that incidental difficulties in the course of the sexual response cycle are not regarded by specialists as a disorder to be treated. Nor is it necessary for the diagnosis that the dysfunction occurs in absolutely all situations. The diagnosis of dyspareunia according to the aforementioned classification is made possible by the presence of pain at the vaginal entrance either throughout intercourse or during deep penetration with the penis.
During diagnosis, other potential causes for such complaints, such as insufficient lubrication and vaginismus, should also be excluded. The ICD-10 classification also allows a diagnosis of dyspareunia in men. This is supposed to manifest itself in pain or discomfort during sexual response. In men, other possible somatic causes, such as infection, should also be excluded in this case. In the 1992 ICD-10 classification, vaginismus is a separate disease entity. It can only be diagnosed in women and is a condition in which the perimenopausal muscles are contracted, making it impossible or difficult to insert the penis into the vagina. The condition can have a primary form, when it occurs from the beginning of sexual contact, or a secondary form when the disorder develops after a period of relatively normal sexual response. In extreme cases, the prospect of sexual contact leads to a generalised reaction with contraction of the thigh adductor muscles. With less severe symptoms, on the other hand, it is possible to have sexual intercourse as long as it does not involve penetration.
A slightly different approach to dyspareunia is provided by the 2013 American classification DS 5. The disorders described above have been combined in this classification into a single entity called genital-pelvic pain/penetration disorder. It applies only to women and consists of chronic or recurrent problems in one or more of the following aspects: during vaginal penetration at sexual intercourse, significant pain in the female external genitalia, vagina or pelvis during intercourse or attempts at penetration, marked fear of pain during intercourse and marked increase in pelvic day muscle tone during attempts at vaginal penetration.
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The last condition is a direct reference to what is called vaginismus in the ICD. The DS 5 classification maintains a time criterion of at least six months of symptom duration. In addition, DS makes it possible to distinguish whether the condition is acquired or lifelong, whether it is a generalised or situational form (occurring only with certain types of stimulation, situations, or with certain partners), and gives the possibility to distinguish three degrees of severity: mild, moderate and severe.
