Gender and Sexual Disorders 503
Sexual Pain Disorders
Some people experience signifi cant pain with sexual activity, particularly with sex-
ual intercourse. DSM-IV-TR specifi es two sexual dysfunctions that are related to
consistent pain associated with sexual intercourse, dyspareunia and vaginismus,
which are discussed in the following sections.
Dyspareunia
Dyspareuniais characterized by recurrent or persistent genital pain that is associ-
ated with sexual intercourse (see Table 11.5). In men, dyspareunia is rare (Bancroft,
1989; Sadock, 1995). When it does occur in men, the pain occurs after ejaculation
and is often related to a medical condition. Up to 10–20% of women have dyspare-
unia (Laumann, Paik, & Rosen, 1999; Rosen et al., 1993). In women, dyspareunia
may be related to a physical condition, such as surgical scar tissue or infection, or to
insuffi cient lubrication, as can occur with menopause. When the pain persists, it can
lead to problems with desire or excitement.
Vaginismus
Vaginismus consists of recurrent or persistent involuntary spasms of the musculature
of the outer third of the vagina, which interfere with sexual intercourse (American
Psychiatric Association, 2000; see Table 11.5). These spasms may be so strong that
it is impossible to insert the penis into the vagina, or at least not without signifi cant
discomfort. Such spasms may also occur when trying to insert a tampon, fi nger,
orspeculum (the device inserted vaginally during a pelvic medical examination).
This diffi culty can lead some women to become afraid of any type of vaginal pen-
etration. A fear of penetration related to vaginismus is distinguished from sexual
aversion: With vaginismus, the woman only avoids sexual activities that involve
vaginal insertion, not all sexual activities.
Most women with vaginismus also have dyspareunia (Heiman, 2002b). Dys-pareunia can make vaginismus worse as a woman tenses certain vaginal muscles
when she anticipates intercourse (Carey & Gordon, 1995; Tollison & Adams, 1979).
Although vaginismus can lead to problems in the desire phase or excitement phase
of the sexual response cycle, it typically does not (Kolodny, Masters, & Johnson,
1979). Further, other forms of sexual stimulation are usually satisfying. As with
premature ejaculation, the desire to become pregnant is the most common reason
why women with vaginismus seek treatment (Leiblum, Pervin, & Campbell, 1989).
Like most women with vaginismus, Lynn in Case 11.14 also has dyspareunia.
S l P i Di d
sexual and easily aroused in foreplay but has always felt that intercourse is the only “accept-
able” way to reach orgasm.
In other areas of their marriage, including rearing of their two children, managing the
family restaurant, and socializing with friends, the Alberts are highly compatible. Despite
these strong points, however, they are near separation because of the tension produced by
their mutual sexual disappointment.
(Spitzer et al., 2002, pp. 266–267)CASE 11.14 • FROM THE INSIDE: LYNN Vaginismus and Dyspareunia
We’ve been married for nine years and have two great kids. Unfortunately, family responsi-
bilities and high stress jobs really cut into our together time. Exhaustion makes sex seem like
an extra chore—just one more thing to do that we don’t have time to enjoy and now can’t. I
don’t know if it’s from the busy, stressful lifestyle or not, or from being “out of practice,” but
about a year ago intercourse began to really hurt. It started with a burning sensation some of
the time during sex. I found myself getting more anxious that it would hurt again and it usu-
ally did. Trips to the doctor revealed little besides the standard “do more foreplay or use more
lubricant” advice. Now it seems like my body just “tightens up” and we can hardly have sex at
all. Entry is painful and besides burning I feel tightness, spasms, discomfort and anxiety. TheDyspareunia
A sexual dysfunction characterized by
recurrent or persistent genital pain that is
associated with sexual intercourse.Vaginismus
A sexual dysfunction in females in which
recurrent or persistent involuntary spasms
of the musculature of the outer third of the
continued on next page vagina interfere with sexual intercourse.