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Fight Dyspareunia: Replace pain with pleasure
Sexuality, Reproduction & Menopause, 10/02/09

Binik YM – In the absence of physical pathology or marital strife, sexual pain has historically been seen as a “sex problem” caused by a variety of factors, ranging from a history of abuse to lowered sexual arousal secondary to inadequate technique. Patients saw sexologists for treatment, which usually involved efforts to increase arousal or to work through trauma. There is no published evidence to suggest that improving a patient’s sex life resolves dyspareunia for most women. Pain stems from physical and psychological factors, both of which must be addressed in a comprehensive assessment. In short, the pain is not sexual, the sex is painful. Viewing sexual pain as a chronic pain syndrome has practical implications for treatment approaches, many of which have proven successful. Additionally, more precise language is evolving to describe sexual pain, as mental health professionals and gynecologists take another look at this phenomenon that troubles many premenopausal and postmenopausal patients.

• A pitfall in the assessment of patients who report pain during sex is over–estimating the link with sexual abuse.
• It is critical that one clinician take responsibility for patient referral to different specialists.
• Recent reports suggest that the link between urogenital atrophy and pain is weaker than once thought.